Community‐Associated Methicillin‐Resistant<i>Staphylococcus aureus</i>and HIV: Intersecting Epidemics

Popovich, Kyle J.; Weinstein, Robert A.; Aroutcheva, Alla; Rice, Thomas W.; Hota, Bala

doi:10.1086/651076

Cited by 93 publications

(102 citation statements)

References 35 publications

(33 reference statements)

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“…Several studies have reported an increased risk of MRSA colonization and infection in HIV-infected individuals compared with the general population [28][29][30][31][32]. The prevalence of MRSA in Denmark is low [16] and, correspondingly, rates were low among HIV-infected individuals and comparable to those in the general population.…”

Section: Discussionmentioning

confidence: 99%

Major but differential decline in the incidence of Staphylococcus aureus bacteraemia in HIV‐infected individuals from 1995 to 2007: a nationwide cohort study^*

et al. 2011

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all Danish HIV-infected individuals (n 5 4871) and population controls (n 5 92 116) matched on age and sex were enrolled in a cohort and all cases of SAB were registered. IRs and risk factors were estimated using time-updated Poisson regression analysis. ResultsWe identified 329 cases of SAB in 284 individuals, of whom 132 individuals were infected with HIV and 152 were not [crude IR ratio (IRR) 24.2; 95% confidence interval (CI) 19.5-30.0, for HIV-infected vs. non-HIV-infected individuals]. Over time, IR declined for HIV-infected individuals (IRR 0.40). Injecting drug users (IDUs) had the highest incidence and the smallest decline in IR, while men who have sex with men (MSM) had the largest decline over time. Among HIV-infected individuals, a latest CD4 count o100 cells/mL was the strongest independent predictor of SAB (IRR 10.2). Additionally, HIV transmission group was associated with risk of SAB. MSM were more likely to have hospital-acquired SAB, a low CD4 cell count and AIDS at the time of HIV acquisition compared with IDUs. ConclusionsWe found that the incidence of SAB among HIV-infected individuals declined during the study period, but remained higher than that among HIV-uninfected individuals. There was an unevenly distributed burden of SAB among HIV transmission groups (IDU4MSM). Low CD4 cell count and IDU were strong predictors of SAB among HIV-infected individuals.

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Section: Discussionmentioning

confidence: 99%

Major but differential decline in the incidence of Staphylococcus aureus bacteraemia in HIV‐infected individuals from 1995 to 2007: a nationwide cohort study^*

et al. 2011

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“…At the Cook County Hospital and its associated clinics in Chicago, CA-MRSA and CA-MSSA (criteria for community-associated infections were not provided) SSTIs were retrospectively reviewed for 2000 to 2007, and population-based incidence estimates were calculated. HIV-infected patients were more likely to have CA-MRSA SSTIs than were non-HIV-infected patients (incidence of 952 versus 156/100,000 population; RR, 6.1; P Ͻ 0.001) (733).…”

Section: Military Populationsmentioning

confidence: 96%

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

2010

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SUMMARY Staphylococcus aureus is an important cause of skin and soft-tissue infections (SSTIs), endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, foreign-body infections, and sepsis. Methicillin-resistant S. aureus (MRSA) isolates were once confined largely to hospitals, other health care environments, and patients frequenting these facilities. Since the mid-1990s, however, there has been an explosion in the number of MRSA infections reported in populations lacking risk factors for exposure to the health care system. This increase in the incidence of MRSA infection has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). CA-MRSA strains differ from the older, health care-associated MRSA strains; they infect a different group of patients, they cause different clinical syndromes, they differ in antimicrobial susceptibility patterns, they spread rapidly among healthy people in the community, and they frequently cause infections in health care environments as well. This review details what is known about the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection. It also addresses the therapy of these infections and strategies for their prevention.

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“…In the last decade, a number of reports have described the disproportionate impact of CA-MRSA on people with HIV infection [7], and the high rate of recurrence of SSTIs in this population [8,9]. Previous reports examining the risk factors for SSTIs in HIV-infected cohorts have limited themselves to culture-positive SSTIs [10][11][12][13][14][15][16][17][18], have only described the characteristics of patients who developed SSTIs [10,14,16,17,19], or were performed in demographically restricted cohorts [10-13, 15, 20-22]. Furthermore, perhaps because of differences in study design, these reports have had conflicting results regarding the immunologic and epidemiologic factors associated with an elevated risk of SSTIs in this population, and the role that trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis for Pneumocystis or toxoplasmosis may play in mitigating this risk [23,24].…”

Section: Introductionmentioning

confidence: 99%

Predictors of skin and soft tissue infections in HIV-infected outpatients in the community-associated methicillin-resistant Staphylococcus aureus era

Hemmige

McNulty

Silverman

et al. 2014

Eur J Clin Microbiol Infect Dis

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Skin and soft tissue infections (SSTIs) are common in the era of community-associated methicillin-resistant Staphylococcus aureus (MRSA) among human immunodeficiency virus (HIV)-infected patients, but the risk factors are not well defined. We sought to elucidate the risk factors for SSTI occurrence in an HIV cohort. This investigation was a retrospective, single-center cohort study, carried out during the period 2005-2009. In this cohort of 511 HIV-infected individuals, 133 SSTIs occurred in 87 individuals over 1,228.6 person-years of follow-up, for an incidence of 108 SSTIs/1,000 person-years [95 % confidence interval (CI) 87-135]. The incidence declined significantly over time (p < 0.01). In a multivariable Cox regression, diabetes [hazard ratio (HR) 2.01; 95 % CI 1.04-3.89], psoriasis (HR 5.77; 95 % CI 1.86-17.9), lymphedema (HR 6.84; 95 % CI 2.59-18.1), intravenous catheter presence (HR 3.38; 95 % CI 1.00-11.5), and HIV viral load greater than 1,000 copies/mL (HR 2.13; 95 % CI 1.33-3.41) were most strongly associated with development of the first SSTI. Trends toward an association between SSTI risk and Medicaid insurance (HR 1.67; 95 % CI 0.98-2.83) and sexually transmitted disease during follow-up (HR 1.66; 0.99-2.78) were present. CD4+ count and trimethoprim-sulfamethoxazole use were not associated with SSTI risk. HIV-infected individuals are at high risk for SSTIs. In a primarily urban, African-American cohort, we found that a number of immunologic and demographic factors were associated with SSTI risk.

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Community‐Associated Methicillin‐ResistantStaphylococcus aureusand HIV: Intersecting Epidemics

Abstract: HIV-infected patients are at markedly increased risk for CA-MRSA infection. This risk may be amplified by overlapping community networks of high-risk patients that may be targets for prevention efforts.

Cited by 93 publications

References 35 publications

Major but differential decline in the incidence of Staphylococcus aureus bacteraemia in HIV‐infected individuals from 1995 to 2007: a nationwide cohort study^*

Major but differential decline in the incidence of Staphylococcus aureus bacteraemia in HIV‐infected individuals from 1995 to 2007: a nationwide cohort study^*

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

Predictors of skin and soft tissue infections in HIV-infected outpatients in the community-associated methicillin-resistant Staphylococcus aureus era

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Community‐Associated Methicillin‐ResistantStaphylococcus aureusand HIV: Intersecting Epidemics

Abstract: HIV-infected patients are at markedly increased risk for CA-MRSA infection. This risk may be amplified by overlapping community networks of high-risk patients that may be targets for prevention efforts.

Cited by 93 publications

References 35 publications

Major but differential decline in the incidence of Staphylococcus aureus bacteraemia in HIV‐infected individuals from 1995 to 2007: a nationwide cohort study*

Major but differential decline in the incidence of Staphylococcus aureus bacteraemia in HIV‐infected individuals from 1995 to 2007: a nationwide cohort study*

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

Predictors of skin and soft tissue infections in HIV-infected outpatients in the community-associated methicillin-resistant Staphylococcus aureus era

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Major but differential decline in the incidence of Staphylococcus aureus bacteraemia in HIV‐infected individuals from 1995 to 2007: a nationwide cohort study^*

Major but differential decline in the incidence of Staphylococcus aureus bacteraemia in HIV‐infected individuals from 1995 to 2007: a nationwide cohort study^*