title: Trends and factors associated with initial and recurrent methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections among HIV-infected persons: an 18-year study.
abstract: BACKGROUND
  Factors associated with initial methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections (SSTIs) and their recurrence have not been fully elucidated among HIV-infected persons.
  
  
  METHODS
  We retrospectively evaluated a large cohort of HIV-infected patients from 1993 to 2010 for culture-proven MRSA SSTIs. Separate logistic regression models evaluated factors associated with initial and recurrent infections.
  
  
  RESULTS
  Of the 794 patients, 63 (8%) developed an initial infection (19.8 infections/1000 person years [PY]); risk factors included CD4 count <500 cells/mm(3) and HIV RNA level ≥400 copies/mL (P < .01), US Centers for Disease Control and Prevention (CDC) stage C versus A/B (P < .01), and injection drug use (IDU, P < .01). In all, 27% developed recurrence (206 infections/1000 PY); risk factors included hospital admission (P = .02). Minocycline for treatment of the initial infection was associated with an 80% decreased odds for recurrence (P = .03).
  
  
  CONCLUSIONS
  HIV control and avoidance of IDU may be useful in reducing rates of MRSA SSTIs among HIV-infected persons.
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: Kartavya J
authors.initials: KJ
authors.lastname: Vyas
authors.forename: Aladdin H
authors.initials: AH
authors.lastname: Shadyab
authors.forename: Chii-Dean
authors.initials: CD
authors.lastname: Lin
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Crum-Cianflone
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D060085:Coinfection / Q000382:microbiology* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000145:classification / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008911:Minocycline / Q000627:therapeutic use; D015999:Multivariate Analysis; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D013207:Staphylococcal Skin Infections / Q000150:complications* / Q000188:drug therapy; D015819:Substance Abuse, Intravenous; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D012367:RNA, Viral; D008911:Minocycline
keywords: HIV; MRSA; epidemiology; recurrence; risk factors