The incidence of and risk factors for MRSA bacteraemia in an HIV‐infected cohort in the HAART era^*

Abstract

Objectives To define the incidence and risk factors for methicillin resistant Staphylococcus aureus (MRSA) bacteraemia in an HIV‐infected population. Methods From January 1, 2000 to December 31, 2004, we conducted a retrospective cohort study. We identified all cases of Staphylococcus aureus bacteraemia (SAB), including MRSA, among patients enrolled in the Johns Hopkins Hospital out‐patient HIV clinic. A conditional logistic regression model was used to identify risk factors for MRSA bacteraemia compared with methicillin‐sensitive SAB and no bacteraemia in unmatched (1:1) and matched (1:4) nested case‐control analyses, respectively. Results Of 4607 patients followed for a total of 11 020 person‐years (PY) of follow‐up, 216 episodes of SAB occurred (incidence: 19.6 cases per 1000 PY), including 94 cases (43.5%) which were methicillin‐resistant. The incidence of MRSA bacteraemia increased from 5.3 per 1000 PY in 2000–2001 to 11.9 per 1000 PY in 2003–2004 (P=0.001). Multivariate analysis demonstrated that independent predictors of MRSA bacteraemia (vs. no bacteraemia) were injection drug use (IDU), end‐stage renal disease (ESRD) and CD4 count <200 cells/μL. Conclusions MRSA bacteraemia was an increasingly common diagnosis in our HIV‐infected cohort, especially in patients with history of IDU, low CD4 cell count and ESRD.

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

“…Our incidence rate estimates are lower than the estimates in these prior studies, as we included all patients, regardless of hospitalization, in the denominator. [12]. Despite the slight drop in 2008, our conclusion, based on multivariate results, is that the overall incidence of bacteraemia rose slightly during this period, especially after 2004.…”

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

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

“…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.…”

Recurrent Community-Acquired Methicillin-Resistant Staphylococcus aureus Infections in an HIV-Infected Person

“…A review of laboratory results demonstrated an overall mean CD4 cell count of 30 cells/mm 3 (standard deviation [SD], 31) and a mean plasma HIV RNA level of 137,520 copies/ml (SD, 267,090) during this time period. Twenty-six (81%) of the MRSA SSTIs presented at a severely immunosuppressed state (CD4, Ͻ50 cells/mm 3 ), and all 32 SSTIs (100%) occurred at an HIV plasma RNA level of Ͼ1,000 copies/ml. Poor adherence to antiretroviral therapy was noted, with only brief periods of adherence, during this period (Table 1).…”

“…A 27-year-old African-American male was diagnosed with HIV/AIDS in September 1997 after an episode of cryptococcal meningitis and a CD4 cell count of 16 cells/mm 3 . His clinical course was complicated by antiretroviral medication nonadherence; the development of dermatologic conditions, including eosinophilic folliculitis and xerosis; esophageal candidiasis; HIV-associated wasting; and chronic renal dysfunction.…”