OBJECTIVES: Outbreaks of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) have been noted in multiple sites in the United States. This study's purpose was to estimate trends in the incidence of and risk factors for clinically significant MRSA (CS-MRSA) infection in a cohort of HIV-infected adults. DESIGN: A retrospective clinic-based cohort (January 1, 2000-December 31, 2003) study. METHODS: We ascertained all initial episodes of CS-MRSA and categorized them by primary site. Incidence rates were estimated by half year. Risk factors for CA-MRSA infection were identified using Cox modeling. RESULTS: Of 126 potential events, 94 were CS. Their primary sources were 83% skin or soft tissue, 10% blood, 6% respiratory, and 1.0% other sites. Among these, 60% were CA and 40% were nosocomial. Of antibiotics tested, only cotrimoxazole resistance was associated with nosocomial acquisition. The 3455 patients contributed 7003 person-years at risk. The incidence of CS-MRSA infection increased 6.2-fold from the first to the last half year. In multivariate analysis, independent predictors of CA-MRSA infection included HIV transmission by men who have sex with men or by injection drug use, CD4 count <50 cells/muL, log10 HIV plasma viral load, and absence of cotrimoxazole prophylaxis. CONCLUSIONS: The incidence of initial CS-MRSA events increased more than 6-fold in a 4-year period. The associations between CA-MRSA infection and HIV severity indicators merit examination in other cohorts.
OBJECTIVES: Outbreaks of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) have been noted in multiple sites in the United States. This study's purpose was to estimate trends in the incidence of and risk factors for clinically significant MRSA (CS-MRSA) infection in a cohort of HIV-infected adults. DESIGN: A retrospective clinic-based cohort (January 1, 2000-December 31, 2003) study. METHODS: We ascertained all initial episodes of CS-MRSA and categorized them by primary site. Incidence rates were estimated by half year. Risk factors for CA-MRSA infection were identified using Cox modeling. RESULTS: Of 126 potential events, 94 were CS. Their primary sources were 83% skin or soft tissue, 10% blood, 6% respiratory, and 1.0% other sites. Among these, 60% were CA and 40% were nosocomial. Of antibiotics tested, only cotrimoxazole resistance was associated with nosocomial acquisition. The 3455 patients contributed 7003 person-years at risk. The incidence of CS-MRSA infection increased 6.2-fold from the first to the last half year. In multivariate analysis, independent predictors of CA-MRSA infection included HIV transmission by men who have sex with men or by injection drug use, CD4 count <50 cells/muL, log10 HIV plasma viral load, and absence of cotrimoxazole prophylaxis. CONCLUSIONS: The incidence of initial CS-MRSA events increased more than 6-fold in a 4-year period. The associations between CA-MRSA infection and HIV severity indicators merit examination in other cohorts.
Authors: Michelle Barton; Michael Hawkes; Dorothy Moore; John Conly; Lindsay Nicolle; Upton Allen; Nora Boyd; Joanne Embree; Liz Van Horne; Nicole Le Saux; Susan Richardson; Aideen Moore; Dat Tran; Valerie Waters; Mary Vearncombe; Kevin Katz; J Scott Weese; John Embil; Marianna Ofner-Agostini; E Lee Ford-Jones Journal: Can J Infect Dis Med Microbiol Date: 2006-09 Impact factor: 2.471
Authors: John S Cho; Eric M Pietras; Nairy C Garcia; Romela Irene Ramos; David M Farzam; Holly R Monroe; Julie E Magorien; Andrew Blauvelt; Jay K Kolls; Ambrose L Cheung; Genhong Cheng; Robert L Modlin; Lloyd S Miller Journal: J Clin Invest Date: 2010-04-01 Impact factor: 14.808
Authors: Ashok Srinivasan; Steven Seifried; Liang Zhu; Wally Bitar; Deo K Srivastava; Jerry L Shenep; Matthew J Bankowski; Patricia M Flynn; Randall T Hayden Journal: AIDS Res Hum Retroviruses Date: 2009-12 Impact factor: 2.205