Staphylococcal infections and kidney disease

Abstract

Staphylococcus aureus is related to the onset of diseases that range from simple infections (cellulitis, folliculitis, impetigo) to severe infections (pneumonia, meningitis, endocarditis, septic shock, septicemia, osteomyelitis, septic arthritis, and others), and it is considered the second most common pathogen involved in bloodstream infections (bacteremia). Important risk factors for severe infections are heart disease, diabetes mellitus, obstructive pulmonary disease, and neoplasms, but the highest risk involves patients on hemodialysis, peritoneal dialysis, HIV patients, and transplant patients. The association between the nephrologist’s daily routine and Staphylococcus occurs in several ways that include practically all activities related to the specialty (chronic renal replacement therapy, acute kidney injury, interventional nephrology, and clinical nephrology). Of the total of S. aureus-associated bacteremia, 15-66% occur in individuals with dialytic chronic kidney disease, and, in dialysis patients, this pathogen accounts for approximately 40% of severe infections. Patients on chronic hemodialysis are colonized by methicillin-resistant Staphylococcus aureus (MRSA) in approximately 3-20% of cases, reaching 65% in some studies. Infections resulting from bacteremia associated with vascular access in hemodialysis patients are endocarditis, osteomyelitis, septic arthritis, and sepsis. Sepsis is the main cause of association with acute kidney injury (AKI) in hospitals and intensive care units. Approximately 50% of AKI patients in the intensive care setting have sepsis. Chronic dialysis patients have a 40-fold higher risk than the general population to develop severe sepsis, as well as a higher risk of death.