Prevalence and risk factors for methicillin-resistant Staphylococcus aureus in an HIV-positive cohort
Prevalence and risk factors for methicillin-resistant Staphylococcus aureus in an HIV-positive cohort
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DOI：
10.1016/j.ajic.2014.12.024
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发表时间：
2015-04-01
影响因子：
4.9
通讯作者：
Carroll, Karen
中科院分区：
文献类型：
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作者：
Farley, Jason E.;Hayat, Matthew J.;Carroll, Karen
背景：艾滋病毒携带者(PLWH)携带甲氧西林耐药金黄色葡萄球菌(MRSA)的比例较高。我们的目标是评估MRSA在PLWHs定植的患病率和风险。方法：从马里兰州巴尔的摩的约翰霍普金斯大学艾滋病服务中心招募成年人。完成了风险问卷调查和标本采集，包括培养、药敏和基因分型。结果：在500名参与者中，大多数是黑人(69%)，接受抗逆转录病毒治疗(ART)(87%)，病毒载量检测不到(73.4%)。CD_4细胞计数的中位数为487个/mm(3)(四分位数范围为316-676.5个/mm(3))。MRSA的感染率为15.4%，主要来自鼻孔(59.7%)。40%的人鼻孔呈阴性，但在其他地方定居。较低的定居几率与最近的性行为(调整后的优势比[AOR]=0.84，P<；.001)和抗逆转录病毒治疗(AOR=0.85，P=.011)有关。风险增加与较低的收入(75,000美元；AOR=2.68，P<；.001)、最近住院(AOR=1.54，P<；.001)、监禁(AOR=1.55，P<；.001)、使用街头毒品(AOR=1.43，P<；.001)和皮肤脓肿(AOR=1.19，P<；.001)有关。结论：即使MRSA患病率很高，仅通过鼻孔监测发现的比例很低，这表明筛查多个解剖部位的重要性。没有发现与同性伴侣或黑人种族有关的因素。预防耐甲氧西林金黄色葡萄球菌可能是抗逆转录病毒治疗的一个好处。版权所有(C)2015年，感染控制和流行病学专业人士协会。Elsevier Inc.出版。
Background: Persons living with HIV (PLWH) are disproportionately burdened with methicillin-resistant Staphylococcus aureus (MRSA). Our objective was to evaluate prevalence and risks for MRSA colonization in PLWH.Methods: Adults were recruited from Johns Hopkins University AIDS Service in Baltimore, Maryland. A risk questionnaire and specimen collection from anatomic sites with culture susceptibility and genotyping were completed. Generalized estimating equation modeling identified MRSA colonization risk factors.Results: Of 500 participants, mostwere black (69%), on antiretroviral therapy (ART) (87%), with undetectable viral loads (73.4%). Median CD4 count was 487 cells/mm(3) (interquartile range, 316-676.5 cells/mm(3)). MRSA prevalence was 15.4%, predominantly from the nares (59.7%). Forty percent were nares negative but were colonized elsewhere. Lower odds for colonizationwere associated with recent sexual activity (adjusted odds ratio [AOR] = 0.84, P < .001) and ART (AOR = 0.85, P = .011). Increased odds were associated with lower income ($75,000; AOR = 2.68, P < .001), recent hospitalization (AOR = 1.54, P < .001), incarceration (AOR = 1.55, P < .001), use of street drugs (AOR = 1.43, P < .001), and skin abscess (AOR = 1.19, P < .001).Conclusions: Even with high MRSA prevalence, the proportion identified through nares surveillance alone was low, indicating the importance of screening multiple anatomic sites. Associations were not found with same-sex coupling or black race. MRSA prevention might be a benefit of ART in PLWH. Copyright (C) 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc.