Incidence of and Risk Factors for Clinically Significant Methicillin-Resistant Staphylococcus aureus Infection in a Cohort of HIV-Infected Adults

Mathews, W. Christopher; Caperna, Joseph; Barber, Randy; Torriani, Francesca J.; Miller, Loren G.; May, Susanne; McCutchan, J. Allen

doi:10.1097/01.qai.0000179464.40948.b9

Cited by 109 publications

(135 citation statements)

References 25 publications

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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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“…8 CA-MRSA strains typically carry the staphylococcal chromosomal cassette mec (SCCmec) type IV or V resistance determinant conferring methicillin resistance, the Panton-Valentine leukocidin (PVL) genetic determinant and are more susceptible to non-b-lactam antibiotics than hospital-associated strains. [9][10][11] Risk factors for CA-MRSA, derived from early outbreak reports, [12][13][14][15][16][17][18][19][20] are notably different from risk factors for health care-associated MRSA (HA-MRSA). 5 Although early outbreak reports of CA-MRSA were generally confined to specific populations, CA-MRSA has now established itself in the United States and other jurisdictions 21 as the predominant pathogen causing purulent skin and soft tissue infections (SSTIs).…”

Section: Ré Sumémentioning

confidence: 99%

Prevalence of methicillin-resistant Staphylococcus aureus in skin and soft tissue infections in patients presenting to Canadian emergency departments

Borgundvaag

Rowe

et al. 2013

CJEM

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Background:Community-associated methicillin-resistantStaphylococcus aureus(MRSA) is an increasingly common cause of skin and soft tissue infection (SSTI) worldwide. The prevalence of MRSA in SSTIs across Canada has not been well described. Studies in the United States have shown significant geographic variability in the prevalence of MRSA. This study characterizes the geographic prevalence and microbiology of MRSA in patients presenting to Canadian emergency departments with SSTIs.Methods:Using a prospective, observational design, we enrolled patients with acute purulent SSTIs presenting to 17 hospital emergency departments and 2 community health centres (spanning 6 Canadian provinces) between July 1, 2008, and April 30, 2009. Eligible patients were those whose wound cultures grewS. aureus. MRSA isolates were characterized by antimicrobial susceptibility testing and pulsed-field gel electrophoresis. All patients were subjected to a structured chart audit, and patients whose wound swabs grew MRSA were contacted by telephone to gather detailed information regarding risk factors for MRSA infection, history of illness, and outcomes.Results:Of the 1,353S. aureus–positive encounters recorded, 431 (32%) grew MRSA and 922 (68%) wounds grew methicillin-susceptibleS. aureus. We observed significant variation in both the prevalence of MRSA (11–100%) and the proportion of community-associated strains of MRSA (0– 100%) across our study sites, with a significantly higher prevalence of MRSA in western Canada.Interpretation:MRSA continues to emerge across Canada, and the prevalence of MRSA in SSTIs across Canada is variable and higher than previously expected.

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“…In recent years, methicillin-resistant Staphylococcus aureus (MRSA) infection has emerged as a significant complication among HIV-infected subjects [10][11][12][13][14].…”

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confidence: 99%

Incidence of and risk factors for bacteraemia in HIV-infected adults in the era of highly active antiretroviral therapy

Wilson

et al. 2011

HIV Medicine

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Background HIV‐infected patients have an increased risk for bacteraemia compared with HIV‐negative patients. Few data exist on the incidence of and risk factors for bacteraemia across time in the current era of highly active antiretroviral therapy (HAART). Methods We assessed the incidence of bacteraemia among patients followed between 2000 and 2008 at 10 HIV Research Network sites. This large multisite, multistate clinical cohort study collected demographic, clinical and therapeutic data longitudinally. International Statistical Classification of Diseases and Related Health Problems (ICD)‐9 codes were examined to identify all cases of in‐patient bacteraemia. Logistic regression analysis was used to assess risk factors for bacteraemia and trends over time in the odds of bacteraemia. Results A total of 39 318 patients were followed for 146 289 person‐years (PY). During the study period, there were 2025 episodes of bacteraemia (incidence 13.8 events/1000 PY). The most common bacteraemia diagnosis was ‘bacteraemia, not otherwise specified (NOS)’ (51%) followed by Staphylococcus aureus (16%) and Streptococcus species (6.5%). In multivariate analysis, the likelihood of bacteraemia was found to have increased in 2005–2008, compared with 2000. Other factors associated with higher odds of bacteraemia included a history of injection drug use (IDU), age ≥50 years, Black race and greater immunosuppression. Conclusions The likelihood of bacteraemia has risen slightly in recent years. Patients who are Black or have a history of IDU are at higher risk. Further research is needed to identify reasons for this increase and to evaluate programmes designed to reduce the bacteraemia risk.

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Incidence of and Risk Factors for Clinically Significant Methicillin-Resistant Staphylococcus aureus Infection in a Cohort of HIV-Infected Adults

Abstract: The incidence of initial CS-MRSA events increased more than 6-fold in a 4-year period. The associations between CA-MRSA infection and HIV severity indicators merit examination in other cohorts.

Cited by 109 publications

References 25 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^*

Prevalence of methicillin-resistant Staphylococcus aureus in skin and soft tissue infections in patients presenting to Canadian emergency departments

Incidence of and risk factors for bacteraemia in HIV-infected adults in the era of highly active antiretroviral therapy

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Incidence of and Risk Factors for Clinically Significant Methicillin-Resistant Staphylococcus aureus Infection in a Cohort of HIV-Infected Adults

Abstract: The incidence of initial CS-MRSA events increased more than 6-fold in a 4-year period. The associations between CA-MRSA infection and HIV severity indicators merit examination in other cohorts.

Cited by 109 publications

References 25 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*

Prevalence of methicillin-resistant Staphylococcus aureus in skin and soft tissue infections in patients presenting to Canadian emergency departments

Incidence of and risk factors for bacteraemia in HIV-infected adults in the era of highly active antiretroviral therapy

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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^*