title: Specific Behaviors Predict Staphylococcus aureus Colonization and Skin and Soft Tissue Infections Among Human Immunodeficiency Virus-Infected Persons.
abstract: Background.  Few data exist on the incidence and risk factors of Staphylococcus aureus colonization and skin and soft tissue infections (SSTIs) among patients infected with human immunodeficiency virus (HIV). Methods.  Over a 2-year period, we prospectively evaluated adults infected with HIV for incident S aureus colonization at 5 body sites and SSTIs. Cox proportional hazard models using time-updated covariates were performed. Results.  Three hundred twenty-two participants had a median age of 42 years (interquartile range, 32-49), an HIV duration of 9.4 years (2.7-17.4), and 58% were on highly active antiretroviral therapy (HAART). Overall, 102 patients (32%) became colonized with S aureus with an incidence rate of 20.6 (95% confidence interval [CI], 16.8-25.0) per 100 person-years [PYs]. Predictors of colonization in the final multivariable model included illicit drug use (hazard ratios [HR], 4.26; 95% CI, 1.33-13.69) and public gym use (HR 1.66, 95% CI, 1.04-2.66), whereas antibacterial soap use was protective (HR, 0.50; 95% CI, 0.32-0.78). In a separate model, perigenital colonization was associated with recent syphilis infection (HR, 4.63; 95% CI, 1.01-21.42). Fifteen percent of participants developed an SSTI (incidence rate of 9.4 cases [95% CI, 6.8-12.7] per 100 PYs). Risk factors for an SSTI included incident S aureus colonization (HR 2.52; 95% CI, 1.35-4.69), public shower use (HR, 2.59; 95% CI, 1.48-4.56), and hospitalization (HR 3.54; 95% CI, 1.67-7.53). The perigenital location for S aureus colonization was predictive of SSTIs. Human immunodeficiency virus-related factors (CD4 count, HIV RNA level, and HAART) were not associated with colonization or SSTIs. Conclusions.  Specific behaviors, but not HIV-related factors, are predictors of colonization and SSTIs. Behavioral modifications may be the most important strategies in preventing S aureus colonization and SSTIs among persons infected with HIV.
authors.affiliation: Infectious Disease Clinical Research Program ; Infectious Disease Clinic , Naval Medical Center San Diego , California.
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Crum-Cianflone
authors.affiliation: Infectious Disease Clinical Research Program ; Henry M. Jackson Foundation for Advancement of Military Medicine , Bethesda, Maryland.
authors.forename: Xun
authors.initials: X
authors.lastname: Wang
authors.affiliation: Infectious Disease Clinical Research Program ; Infectious Disease Clinic , Walter Reed Army Medical Center , Washington, District of Columbia.
authors.forename: Amy
authors.initials: A
authors.lastname: Weintrob
authors.affiliation: Infectious Disease Clinical Research Program ; Infectious Disease Clinic , Naval Medical Center Portsmouth , Virginia.
authors.forename: Tahaniyat
authors.initials: T
authors.lastname: Lalani
authors.affiliation: Infectious Disease Clinical Research Program ; Infectious Disease Clinic , Naval Medical Center San Diego , California.
authors.forename: Mary
authors.initials: M
authors.lastname: Bavaro
authors.affiliation: Infectious Disease Clinical Research Program.
authors.forename: Jason F
authors.initials: JF
authors.lastname: Okulicz
authors.affiliation: Infectious Disease Clinical Research Program ; Henry M. Jackson Foundation for Advancement of Military Medicine , Bethesda, Maryland.
authors.forename: Katrin
authors.initials: K
authors.lastname: Mende
authors.affiliation: Department of Medicine , Uniformed Services University of the Health Sciences , Bethesda, Maryland.
authors.forename: Michael
authors.initials: M
authors.lastname: Ellis
authors.affiliation: Infectious Disease Clinical Research Program ; Henry M. Jackson Foundation for Advancement of Military Medicine , Bethesda, Maryland.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Agan
keywords: HIV; MRSA; Staphylococcus aureus; behaviors; colonization; human immunodeficiency virus; risk factors; skin and soft tissue infections