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American Journal of Kidney Diseases

Aspirin Treatment Is Associated With a Significantly Decreased Risk of Staphylococcus aureus Bacteremia in Hemodialysis Patients With Tunneled Catheters

Published:February 03, 2007DOI:https://doi.org/10.1053/j.ajkd.2006.12.014

      Background

      Hemodialysis patients with tunneled catheters are at increased risk of bacteremic Staphylococcus aureus infections. In vitro and in vivo studies showed that aspirin has direct antistaphylococcal effects by inhibiting expression of α-toxin and matrix adhesion genes through activation of sigma factor B stress-induced operon. We hypothesized that long-term treatment with aspirin may decrease the frequency of S aureus bacteremia in such patients.

      Methods

      We retrospectively analyzed electronic medical records for a variety of clinical parameters, including catheter dwell times, blood culture results, and aspirin use in our dialysis population.

      Results

      A total of 4,722 blood cultures were performed in 872 patients during more than 476 patient-catheter-years. There was a lower rate of catheter-associated S aureus bacteremia in patients treated with aspirin versus those not treated with aspirin (0.17 versus 0.34 events/patient-catheter-year, P = 0.003), whereas no such difference was observed for other bacteria. This association was dose dependent, seen mostly with the 325-mg aspirin dose. Using the Cox proportional hazard method, risk to develop a first episode of S aureus bacteremia decreased by 54% in patients using aspirin (confidence interval, 24 to 72; P = 0.002). Aspirin was associated with decreased risk of: (1) a first episode of methicillin-resistant S aureus bacteremia and (2) metastatic complications during the first episode of catheter-related S aureus bacteremia.

      Conclusion

      These data are consistent with our clinical hypothesis that aspirin has a clinically useful antistaphylococcal effect in the dialysis population.

      Index Words

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      Linked Article

      • Direct Antistaphylococcal Effects of High-Dose Aspirin in Hemodialysis Patients?
        American Journal of Kidney DiseasesVol. 50Issue 2
        • Preview
          In their retrospective study, Sedlacek et al1 demonstrated that high-dose (324 mg) aspirin, rather than the 81-mg “baby” aspirin, was associated with decreased risk of Staphylococcus aureus bacteremia in hemodialysis patients with tunneled catheters. However, this high-dose aspirin in hemodialysis patients might deplete the iron store2 due to bleeding diathesis, and subsequently interfere with host immunity.
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      • Decreasing Risk of Staphylococcus Aureus Infections
        American Journal of Kidney DiseasesVol. 50Issue 2
        • Preview
          Understanding the epidemiology of Staphylococcus aureus infections is important because of resistance to antimicrobial treatment. The study of Sedlack et al shows a lower frequency of infections in patients treated with aspirin.1 In other studies, the most important risk factor for infection is nasal colonization of S aureus.2 In a recent study we showed that nasal carriage was significantly lower in those using aspirin for prophylaxis of cardiovascular disease compared to those not using aspirin.
        • Full-Text
        • PDF
      • In Reply
        American Journal of Kidney DiseasesVol. 50Issue 2
        • Preview
          Karabay et al make a fascinating comment on the impact of aspirin on nasal Staphylococcus colonization.1 The lack of a dose-response effect for colonization versus the presence of a dose-response effect for prevention of catheter-related bacteremia is not at all surprising. It is highly likely that virulence factors important for colonization (eg, teichoic acid or capsule) are distinct from those which underlie the pathogenesis of vascular infections (eg, microbial surface components recognizing adhesive matrix molecules [MSCRAMMs], alpha toxin), and that their regulation and expression may be either dose dependent or not.
        • Full-Text
        • PDF