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Risk factors for colonization or infection due to methicillin-resistant Staphylococcus aureus in HIV-positive
M Onorato1, M J Borucki, G Baillargeon
1Department of Internal Medicine, University of Texas Medical Branch Hospitals and Clinics, Galveston 77555-0835, USA.
Objective:
To determine the risk factors for colonization or infection with methicillin-resistant Staphylococcus aureus in human immunodeficiency virus (HIV)-infected patients.
Design:
Retrospective matched-pair case-control study.
Setting:
Continuity clinic and inpatient HIV service of a university medical center.
Population:
Patients with HIV infection from the general population of eastern and coastal Texas and from the Texas Department of Criminal Justice.
Data Collection:
Patient charts and the AIDS Care and Clinical Research Program Database were reviewed for the following: age, race, number of admissions, total hospital days, presence of a central venous catheter, serum albumin, total white blood cell count and absolute neutrophil count, invasive or surgical procedures, any cultures positive for S. aureus, and a history of opportunistic illnesses, diabetes, or dermatologic diagnoses. Data also were collected on the administration of antibiotics, antiretroviral therapy, steroids, cancer chemotherapy, and subcutaneous medications.
Results:
In the univariate analysis, the presence of a central venous catheter, an underlying dermatologic disease, lower serum albumin, prior steroid therapy, and prior antibiotic therapy, particularly antistaphylococcal therapy or multiple courses of antibiotics, were associated with increased risk for colonization or infection with methicillin-resistant S. aureus. Multivariate analysis yielded a model that included presence of a central venous catheter, underlying dermatologic disease, broad-spectrum antibiotic exposure, and number of hospital days as independent risk factors for colonization or infection with methicillin-resistant S. aureus.
Conclusions:
In our HIV-infected patient population, prior hospitalization, exposure to broad-spectrum antibiotics, presence of a central venous catheter, and dermatologic disease were risk factors for acquisition of methicillin-resistant S. aureus.
Insights
Central venous catheters, dermatologic disease, and broad-spectrum antibiotic exposure are key risk factors for methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in patients with human immunodeficiency virus (HIV). Prior hospitalization also increases risk.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- HIV Medicine
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat, particularly to immunocompromised populations.
- Understanding specific risk factors for MRSA colonization or infection in human immunodeficiency virus (HIV)-infected patients is crucial for targeted prevention strategies.
Purpose of the Study:
- To identify and characterize the risk factors associated with MRSA colonization or infection among patients with HIV.
Main Methods:
- A retrospective matched-pair case-control study was conducted.
- Data were collected from patient charts and a specialized database, including demographics, clinical history, laboratory values, and treatment exposures.
- Multivariate analysis was employed to determine independent risk factors.
Main Results:
- Univariate analysis indicated that central venous catheters, dermatologic disease, low serum albumin, and prior antibiotic/steroid therapy were associated with increased MRSA risk.
- Multivariate analysis identified central venous catheter, dermatologic disease, broad-spectrum antibiotic exposure, and number of hospital days as independent risk factors.
Conclusions:
- In HIV-infected individuals, prior hospitalization, broad-spectrum antibiotic exposure, central venous catheter presence, and dermatologic disease are significant risk factors for acquiring MRSA.