Risks for methicillin-resistant Staphylococcus aureus colonization or infection among patients with HIV infection.
BACKGROUND
Risks for methicillin-resistant Staphylococcus aureus (MRSA) among those with HIV infection have been found to vary, and the epidemiology of USA-300 community-acquired (CA) MRSA has not been adequately described.


METHODS
We conducted a retrospective review of HIV-infected out-patients from January 2002 to December 2007 and employed multivariate logistic regression (MLR) to identify risks for MRSA colonization or infection. Pulsed-field gel electrophoresis (PFGE) was used to identify USA-300 strains.


RESULTS
Seventy-two (8%) of 900 HIV-infected patients were colonized or infected with MRSA. MLR identified antibiotic exposure within the past year [odds ratio (OR) 3.4; 95% confidence interval (CI) 1.5-7.7] and nadir CD4 count <200 cells/microL (OR 2.5; 95% CI 1.2-5.3) as risks for MRSA colonization or infection. Receipt of antiretroviral therapy (ART) within the past year was associated with decreased risk (OR 0.16; 95% CI 0.07-0.4). Eighty-nine percent of available strains were USA-300. MLR identified skin or soft tissue infection (SSTI) as the only predictor for infection with USA-300 (OR 5.9; 95% CI 1.4-24.3).


CONCLUSIONS
Significant risks for MRSA among HIV-infected patients were CD4 count nadir <200 cells/microL and antibiotic exposure. Only the presence of an SSTI was associated with having USA-300, and thus the use of patient characteristics to predict those with USA-300 was limited. In addition, ART within the previous year significantly reduced the risk of MRSA colonization or infection.
Ramsetty
S K
SK
Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC 29425, USA. ramsett@musc.edu
Stuart
L L
LL
Blake
R T
RT
Parsons
C H
CH
Salgado
C D
CD
D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology*; D015897:Comorbidity; D016521:Electrophoresis, Gel, Pulsed-Field; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D010045:Outpatients; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology; D013207:Staphylococcal Skin Infections / Q000453:epidemiology / Q000382:microbiology*; D019562:Viral Load; D055815:Young Adult
D000900:Anti-Bacterial Agents; D044966:Anti-Retroviral Agents