Recurrent community-associated methicillin-resistant Staphylococcus aureus infections among HIV-infected persons: incidence and risk factors

AIDS Patient Care STDS. 2009 Jul;23(7):499-502. doi: 10.1089/apc.2008.0240.

Abstract

Community-associated methicillin-resistant Staphylococcus aureus (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 Centers for Disease Control and Prevention (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 patients with HIV had wound culture-proven CA-MRSA SSTIs for an incidence rate of 12.3 infections per 1000 person-years. Those who developed a MRSA infection had a mean age of 40 years, 97% were male, 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 4 months (range, 1-20 months). Suppressed HIV-1 RNA levels of less than 1000 copies per milliliter (odds ratio [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 may be associated with a reduced risk of recurrent skin/soft tissue infections.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • California / epidemiology
  • Community-Acquired Infections / epidemiology
  • HIV Infections / complications*
  • HIV Infections / epidemiology
  • HIV-1 / genetics
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Methicillin Resistance / genetics
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Soft Tissue Infections / epidemiology*
  • Soft Tissue Infections / microbiology
  • Staphylococcal Infections / complications
  • Staphylococcal Infections / epidemiology*
  • Staphylococcal Skin Infections / epidemiology*
  • Wound Infection / microbiology