Methicillin‐resistant Staphylococcus aureus (MRSA) infections among HIV‐infected persons in the era of highly active antiretroviral therapy: a review of the literature

Abstract

Objectives Despite the rise of methicillin‐resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) among HIV‐infected persons during the era of highly active antiretroviral therapy (HAART), the precise relationship between these two infections has not been fully elucidated. Therefore, we provide a comprehensive, literature‐based review of MRSA infections among HIV‐infected persons. Methods A systematic search of MEDLINE using the search terms “HIV” and “MRSA” identified references published during the HAART era (January 1996 to January 2011). Relevant articles on MRSA in the general population were also reviewed for comparison. Results The most common type of MRSA infection among HIV‐infected persons is SSTI caused by USA300, Panton‐Valentine leukocidin (PVL)‐positive strains. HIV‐infected persons have an increased risk for both initial MRSA infections and recurrent infections compared with the general population. Risk factors for MRSA infections in this population include immunosuppression, comorbid conditions and certain lifestyle behaviours such as high‐risk sexual behaviours and illicit drug use. Further research is needed on the optimal treatment and prevention strategies for MRSA infections among HIV‐infected persons. Conclusions HIV‐infected persons have a propensity for MRSA SSTI and a high rate of recurrent disease. The reasons for the elevated rates of MRSA infections among HIV‐infected persons appear to be multifactorial, but may be mitigated with optimized HIV control and reductions in associated risk factors.

Nasal colonization with Staphylococcus aureus in individuals with HIV/ AIDS attended in a Brazilian Teaching Hospital

“…Some risk factors for MRSA infection are indicated for individuals living with HIV, the following being highlighted: the immunosuppressed condition, and associated co-morbidities and specified life-style-related behaviors, such as high-risk sexual practices and the use of illicit drugs (9) .…”

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

“…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].…”

Mechanisms of NDV-3 vaccine efficacy in MRSA skin versus invasive infection

“…Infections due to MRSA are a special concern in immunevulnerable populations, including hemodialysis (22), neutropenic (23,24), transplantation (25), and otherwise immunosuppressed patients (26,27), and in patients with inherited immune dysfunctions (28)(29)(30)(31) or cystic fibrosis (32). Patients having deficient interleukin 17 (IL-17) or IL-22 responses (e.g., signal transduction mediators STAT3, DOCK8, or CARD9 deficiencies) exhibit chronic or "cold" abscesses, despite high densities of pathogens such as S. aureus (33,34).…”