Staphylococcus aureus colonization in a community sample of HIV-infected and HIV-uninfected drug users.
HIV-infected individuals, especially those with a history of injecting drug use, are at high risk of Staphylococcus aureus infection. Moreover, the use of antimicrobial agents for opportunistic infections may increase nasal colonization by antimicrobial-resistant Staphylococcus aureus in this population and, subsequently, levels of infection with multidrug-resistant Staphylococcus aureus in the community. Between February 1999 and March 2000, 500 subjects from a community-based cohort of drug users completed an interview and underwent a physical exam. Risk factors for colonization by Staphylococcus aureus were examined, the antibiotic susceptibility profiles of all strains were determined, and DNA strain analysis was performed. One hundred twenty (24%) subjects had positive Staphylococcus aureus nasal cultures. Only HIV infection and homelessness were associated with Staphylococcus aureus colonization. Ten (8%) isolates were methicillin-resistant Staphylococcus aureus. Methicillin-resistant Staphylococcus aureus isolates were found more frequently among HIV-infected than HIV-uninfected respondents (14% vs. 3%, P=0.04). Among those colonized and HIV infected, the mean number of resistant isolates was higher for those currently reporting antibiotic use (5.0 vs. 2.3, P<0.001) and for those with CD4+ counts <or =200/ microl (3.8 vs. 2.3, P=0.02). The increased use of antimicrobial agents in HIV-infected individuals colonized with Staphylococcus aureus may be an underlying mechanism that contributes to the presence of multidrug-resistant Staphylococcus aureus in the community.
Miller
M
M
Department of Epidemiology, Mailman School of Public Health/Columbia University, 722 West 168th Street, Room 1210, NY 10032, New York, USA. mm35@columbia.edu
Cespedes
C
C
Vavagiakis
P
P
Klein
R S
RS
Lowy
F D
FD
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016022:Case-Control Studies; D015331:Cohort Studies; D015169:Colony Count, Microbial; D024881:Drug Resistance, Bacterial; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011336:Probability; D012016:Reference Values; D012111:Residence Characteristics; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000382:microbiology
D000900:Anti-Bacterial Agents