Recurrent Community-Associated Methicillin-Resistant Staphylococcus aureus Infections among HIV-Infected Persons: Incidence and Risk Factors

Abstract

Community-associated MRSA (CA-MRSA) infections are well described among the general population, but little is known regarding the incidence of and predictors for recurrent CA-MRSA infections among HIV-infected persons. We retrospectively evaluated HIV-infected patients seen at the Naval Medical Center San Diego from January 1, 2000 to June 30, 2007 for wound culture-proven MRSA infections defined as community-associated based on CDC criteria. Data on skin/soft tissue infections (SSTIs) following an initial CA-MRSA infection were collected by review of medical records and culture results. Patients with or without recurrent infections were compared for predictors of recurrence using multivariate logistic regression models. Thirty-one (6.8%) of 458 HIV patients had wound culture-proven CA-MRSA SSTIs for an incidence rate of 12.3 infections/1,000 person-years. Those who developed a MRSA infection had a mean age of 40 years, 97% were male, and 58% were Caucasian, 23% were Hispanic, 16% were African American, and 3% were other; demographics were similar to the overall study population. Fourteen (41%) HIV patients with an initial MRSA infection had recurrent SSTIs; of these, seven (21%) had culture-confirmed recurrent CA-MRSA. The median time between infection recurrences was four months (range one to 20 months). Suppressed HIV-1 RNA levels of <1000 copies/ml (OR 0.14, p=0.03) was associated with a lower rate of SSTI recurrence. In summary, HIV-infected persons have a high incidence of CA-MRSA skin/soft tissue infections and a high rate of recurrence. HIV control is associated with a reduced risk of recurrent skin/soft tissue infections.

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

“…Among 959 Greek Air Force employees in 2004 to 2005, 9 (0.94%) had nasal colonization with MRSA, and 2 of the 9 had no previous known exposure to the health care system (461). 3 , and the HIV viral load was Ͻ1,000 copies/ml in 48% of the patients; 71% of the patients were receiving antiretroviral therapy at the time of their infections (195). A study performed in 2000 to 2003 demonstrated a steady rise in the incidence of MRSA infections among patients at an adult HIV clinic in San Diego from 2 to 5 per 100 patients in a 6-month period (589).…”

“…Culture results were available for only some recurrent lesions; of 14 patients with a CA-MRSA index SSTI and a recurrence, 7 (50%) had a culture-confirmed CA-MRSA SSTI recurrence. Recurrence was associated with an HIV viral load of Ͼ1,000 copies/ml (OR, 0.14; P ϭ 0.03 for patients with a viral load of Ͻ1,000 copies/ml), and there was a trend for an increased risk of recurrence if an incision-and-drainage procedure was not performed for the index CA-MRSA SSTI (OR, 0.19; P ϭ 0.07) (195).…”

Precarious Balance: Th17 Cells in Host Defense

“…Immunocompromised hosts with defects in Th17 expansion, including HIV/AIDS patients and individuals with hyperimmunoglobulin E syndrome (HIES, or Job's syndrome), are susceptible to opportunistic infections by Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae, among others (15,31,59,72). In HIV infection, Th17 cells are preferentially depleted from the gastrointestinal lymphocyte compartment, despite the unresponsiveness of this subset to viral antigens (9).…”

Oral and Airway Microbiota in HIV-Infected Pneumonia Patients

“…Recent studies have demonstrated that microbiota composition defines the behavior and virulence gene expression of primary pathogens (17,30) and host susceptibility to infection (16,30). Hence, a first step toward understanding the contribution of the airway microbiome to recurrent pneumonia in HIV-infected patients (12,27,43) is the identification of organisms present, despite antimicrobial treatment, both in the airway and in the oral cavity, since the latter has long been recognized as a potential microbial reservoir for reinfection of the airways (32,36). Identification of members of the microbiota that is present despite therapeutic intervention provides valuable insights into the efficacy of such treatments and identifies species that may contribute to subsequent pulmonary episodes.…”