title: Prevalence and risk factors for methicillin-resistant Staphylococcus aureus in an HIV-positive cohort.
abstract: BACKGROUND
  Persons living with HIV (PLWH) are disproportionately burdened with methicillin-resistant Staphylococcus aureus (MRSA). Our objective was to evaluate prevalence and risks for MRSA colonization in PLWH.
  
  
  METHODS
  Adults were recruited from Johns Hopkins University AIDS Service in Baltimore, Maryland. A risk questionnaire and specimen collection from anatomic sites with culture susceptibility and genotyping were completed. Generalized estimating equation modeling identified MRSA colonization risk factors.
  
  
  RESULTS
  Of 500 participants, most were black (69%), on antiretroviral therapy (ART) (87%), with undetectable viral loads (73.4%). Median CD4 count was 487 cells/mm(3) (interquartile range, 316-676.5 cells/mm(3)). MRSA prevalence was 15.4%, predominantly from the nares (59.7%). Forty percent were nares negative but were colonized elsewhere. Lower odds for colonization were associated with recent sexual activity (adjusted odds ratio [AOR] = 0.84, P < .001) and ART (AOR = 0.85, P = .011). Increased odds were associated with lower income (<$25,000 vs >$75,000; AOR = 2.68, P < .001), recent hospitalization (AOR = 1.54, P < .001), incarceration (AOR = 1.55, P < .001), use of street drugs (AOR = 1.43, P < .001), and skin abscess (AOR = 1.19, P < .001).
  
  
  CONCLUSIONS
  Even with high MRSA prevalence, the proportion identified through nares surveillance alone was low, indicating the importance of screening multiple anatomic sites. Associations were not found with same-sex coupling or black race. MRSA prevention might be a benefit of ART in PLWH.
authors: Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, MD. Electronic address: Jfarley1@jhu.edu.
authors: Jason E
authors: JE
authors: Farley
authors: Departments of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA.
authors: Matthew J
authors: MJ
authors: Hayat
authors: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
authors: Paul L
authors: PL
authors: Sacamano
authors: Department of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Tracy
authors: T
authors: Ross
authors: Department of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Karen
authors: K
authors: Carroll
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015142:Baltimore; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000382:microbiology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D009666:Nose / Q000382:microbiology; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D013048:Specimen Handling; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D011795:Surveys and Questionnaires; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: Anatomic site; HIV; Methicillin-resistant Staphylococcus aureus; Prevalence; Risk