Trends and factors associated with initial and recurrent methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections among HIV-infected persons: an 18-year study

J Int Assoc Provid AIDS Care. 2014 May-Jun;13(3):206-13. doi: 10.1177/2325957412473780. Epub 2013 Apr 19.

Abstract

Background: Factors associated with initial methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections (SSTIs) and their recurrence have not been fully elucidated among HIV-infected persons.

Methods: We retrospectively evaluated a large cohort of HIV-infected patients from 1993 to 2010 for culture-proven MRSA SSTIs. Separate logistic regression models evaluated factors associated with initial and recurrent infections.

Results: Of the 794 patients, 63 (8%) developed an initial infection (19.8 infections/1000 person years [PY]); risk factors included CD4 count <500 cells/mm(3) and HIV RNA level ≥400 copies/mL (P < .01), US Centers for Disease Control and Prevention (CDC) stage C versus A/B (P < .01), and injection drug use (IDU, P < .01). In all, 27% developed recurrence (206 infections/1000 PY); risk factors included hospital admission (P = .02). Minocycline for treatment of the initial infection was associated with an 80% decreased odds for recurrence (P = .03).

Conclusion: HIV control and avoidance of IDU may be useful in reducing rates of MRSA SSTIs among HIV-infected persons.

Keywords: HIV; MRSA; epidemiology; recurrence; risk factors.

Publication types

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

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Coinfection / microbiology*
  • Coinfection / virology
  • Female
  • HIV Infections / classification
  • HIV Infections / complications*
  • Hospitalization
  • Humans
  • Male
  • Methicillin-Resistant Staphylococcus aureus*
  • Minocycline / therapeutic use
  • Multivariate Analysis
  • RNA, Viral / blood
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Soft Tissue Infections / complications
  • Soft Tissue Infections / drug therapy
  • Soft Tissue Infections / microbiology*
  • Staphylococcal Skin Infections / complications*
  • Staphylococcal Skin Infections / drug therapy
  • Substance Abuse, Intravenous
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • RNA, Viral
  • Minocycline