title: Community-associated methicillin-resistant Staphylococcus aureus bacteremia and endocarditis among HIV patients: a cohort study.
abstract: BACKGROUND
  HIV patients are at increased risk of development of infections and infection-associated poor health outcomes. We aimed to 1) assess the prevalence of USA300 community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) among HIV-infected patients with S. aureus bloodstream infections and. 2) determine risk factors for infective endocarditis and in-hospital mortality among patients in this population.
  
  
  METHODS
  All adult HIV-infected patients with documented S. aureus bacteremia admitted to the University of Maryland Medical Center between January 1, 2003 and December 31, 2005 were included. CA-MRSA was defined as a USA 300 MRSA isolate with the MBQBLO spa-type motif and positive for both the arginine catabolic mobile element and Panton-Valentin Leukocidin. Risk factors for S. aureus-associated infective endocarditis and mortality were determined using logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI). Potential risk factors included demographic variables, comorbid illnesses, and intravenous drug use.
  
  
  RESULTS
  Among 131 episodes of S. aureus bacteremia, 85 (66%) were MRSA of which 47 (54%) were CA-MRSA. Sixty-three patients (48%) developed endocarditis and 10 patients (8%) died in the hospital on the index admission Patients with CA-MRSA were significantly more likely to develop endocarditis (OR = 2.73, 95% CI = 1.30, 5.71). No other variables including comorbid conditions, current receipt of antiretroviral therapy, pre-culture severity of illness, or CD4 count were significantly associated with endocarditis and none were associated with in-hospital mortality.
  
  
  CONCLUSIONS
  CA-MRSA was significantly associated with an increased incidence of endocarditis in this cohort of HIV patients with MRSA bacteremia. In populations such as these, in which the prevalence of intravenous drug use and probability of endocarditis are both high, efforts must be made for early detection, which may improve treatment outcomes.
authors: Oregon Health Science University, Portland, OR, USA.
authors: Jon P
authors: JP
authors: Furuno
authors: Jennifer K
authors: JK
authors: Johnson
authors: Marin L
authors: ML
authors: Schweizer
authors: Anayochukwu
authors: A
authors: Uche
authors: Oscar C
authors: OC
authors: Stine
authors: Simone M
authors: SM
authors: Shurland
authors: Graeme N
authors: GN
authors: Forrest
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D001427:Bacterial Toxins / Q000235:genetics; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005098:Exotoxins / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D020071:Interspersed Repetitive Sequences; D007956:Leukocidins / Q000235:genetics; D008297:Male; D008396:Maryland / Q000453:epidemiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013205:Staphylococcal Protein A / Q000235:genetics; D016019:Survival Analysis; D037521:Virulence Factors / Q000235:genetics
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D013205:Staphylococcal Protein A; D037521:Virulence Factors