title: Community-associated methicillin-resistant Staphylococcus aureus colonization in high-risk groups of HIV-infected patients.
abstract: BACKGROUND
  We examined the epidemiology of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) nasal colonization among 3 groups of human immunodeficiency virus (HIV)-infected and 1 group of HIV-negative outpatients.
  
  
  METHODS
  We determined prevalence and risk factors associated with MRSA colonization among women, recently incarcerated, and Hispanic HIV-infected patients and HIV-negative patients; isolates were typed by pulsed-field gel electrophoresis. Relative prevalence was calculated using Poisson regression, and logistic regression was used for multivariate analysis.
  
  
  RESULTS
  Of 601 patients, 9.3% were colonized with MRSA; 11% of HIV-infected and 4.2% of HIV-negative patients were colonized (relative prevalence, 2.6; 95% confidence interval [CI], 1.12-6.07; P = .03). Among HIV-infected patients, recently incarcerated patients had the highest colonization prevalence (15.6%) followed by women (12%); Hispanic patients had the lowest (2.8%). Eighty percent of confirmed MRSA isolates were identified as USA300. On multivariate analysis, history of incarceration or residence in alternative housing (odds ratio [OR], 2.3; 95% CI, 1.1-4.7; P = .03) was associated with MRSA colonization; Hispanic ethnicity was negatively associated (OR, 0.3; 95% CI, .11-.98; P = .045). There was a trend (OR, 1.6; 95% CI, .9-3.0; P = .097) toward geographic location of residence being associated with colonization. After controlling for incarceration, residence, and geography, HIV status was no longer significantly associated with colonization.
  
  
  CONCLUSIONS
  The CA-MRSA and HIV epidemics have intersected. Examination of networks of individuals released from incarceration, both HIV positive and negative, is needed to assess the role of social networks in spread of CA-MRSA and inform prevention strategies.
authors.affiliation: Rush University Medical Center, Chicago, Illinois 60612, USA. kyle_popovich@rush.edu
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Popovich
authors.forename: Kimberly Y
authors.initials: KY
authors.lastname: Smith
authors.forename: Thana
authors.initials: T
authors.lastname: Khawcharoenporn
authors.forename: C J
authors.initials: CJ
authors.lastname: Thurlow
authors.forename: John
authors.initials: J
authors.lastname: Lough
authors.forename: Guajira
authors.initials: G
authors.lastname: Thomas
authors.forename: Alla
authors.initials: A
authors.lastname: Aroutcheva
authors.forename: Chad
authors.initials: C
authors.lastname: Zawitz
authors.forename: Kathleen G
authors.initials: KG
authors.lastname: Beavis
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
authors.forename: Bala
authors.initials: B
authors.lastname: Hota
mesh_terms: D000328:Adult; D000368:Aged; D017714:Community-Acquired Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D008875:Middle Aged; D009666:Nose / Q000187:drug effects / Q000382:microbiology*; D010641:Phenotype; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology