title: Recurrent community-associated methicillin-resistant Staphylococcus aureus infections among HIV-infected persons: incidence and risk factors.
abstract: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are well described among the general population, but little is known regarding the incidence of and predictors for recurrent CA-MRSA infections among HIV-infected persons. We retrospectively evaluated HIV-infected patients seen at the Naval Medical Center San Diego from January 1, 2000 to June 30, 2007 for wound culture-proven MRSA infections defined as community-associated based on Centers for Disease Control and Prevention (CDC) criteria. Data on skin/soft tissue infections (SSTIs) following an initial CA-MRSA infection were collected by review of medical records and culture results. Patients with or without recurrent infections were compared for predictors of recurrence using multivariate logistic regression models. Thirty-one (6.8%) of 458 patients with HIV had wound culture-proven CA-MRSA SSTIs for an incidence rate of 12.3 infections per 1000 person-years. Those who developed a MRSA infection had a mean age of 40 years, 97% were male, 58% were Caucasian, 23% were Hispanic, 16% were African American, and 3% were other; demographics were similar to the overall study population. Fourteen (41%) HIV patients with an initial MRSA infection had recurrent SSTIs; of these, seven (21%) had culture-confirmed recurrent CA-MRSA. The median time between infection recurrences was 4 months (range, 1-20 months). Suppressed HIV-1 RNA levels of less than 1000 copies per milliliter (odds ratio [OR] 0.14, p = 0.03) was associated with a lower rate of SSTI recurrence. In summary, HIV-infected persons have a high incidence of CA-MRSA skin/soft tissue infections and a high rate of recurrence. HIV control may be associated with a reduced risk of recurrent skin/soft tissue infections.
authors.affiliation: Infectious Disease Clinical Research Program/TriService AIDS Clinical Consortium, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. nancy.crum@med.navy.mil
authors.forename: Nancy
authors.initials: N
authors.lastname: Crum-Cianflone
authors.forename: Jhamillia
authors.initials: J
authors.lastname: Weekes
authors.forename: Mary
authors.initials: M
authors.lastname: Bavaro
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D016106:Methicillin Resistance / Q000235:genetics; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000453:epidemiology* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000150:complications / Q000453:epidemiology*; D013207:Staphylococcal Skin Infections / Q000453:epidemiology*; D014946:Wound Infection / Q000382:microbiology