Community-Associated Methicillin-Resistant Staphylococcus aureus Colonization Burden in HIV-Infected Patients
Community-Associated Methicillin-Resistant Staphylococcus aureus Colonization Burden in HIV-Infected Patients
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DOI：
10.1093/cid/cit010
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发表时间：
2013-04-15
影响因子：
11.8
通讯作者：
Weinstein, Robert A.
中科院分区：
文献类型：
--
作者：
Popovich, Kyle J.;Hota, Bala;Weinstein, Robert A.
背景社区相关耐甲氧西林金黄色葡萄球菌（CA-MRSA）的流行对人类免疫缺陷病毒（HIV）患者产生了不成比例的影响。方法。我们评估了住院72小时内HIV感染者和HIV阴性住院患者中CA-MRSA定植负担（每样本总数的定植部位数）。从2011年3月到2012年4月，我们从鼻和鼻腔部位（咽喉、腋窝、腹股沟、直肠周和慢性伤口（如果存在））获得培养物，并收集风险因素数据。在745例患者（374例HIV感染者，371例HIV阴性）中，15.7%的患者在任何部位定植有CA-MRSA：20%的HIV患者和11%的HIV阴性患者（相对患病率= 1.8，P = 0.002）。HIV感染患者的鼻、鼻、鼻内定植率较高，定植负担也较高。直肠周围和腹股沟区是最常见的鼻腔定植部位，38.5%的定植患者为单纯鼻腔定植。73%的分离株被鉴定为USA 300。在HIV感染者中，男性、年轻和最近的监禁是正相关的，而西班牙裔与更高的殖民负担呈负相关。在HIV阴性患者中，临时住房（无家可归者，庇护所或药物滥用中心）是与较高殖民负担相关的唯一因素。USA 300的预测因子包括HIV、年龄较小、非法药物使用和男性;除1名当前或近期监禁的殖民个体外，所有个体均携带USA 300。HIV感染患者更可能有较高的CA-MRSA定植负担并携带USA 300。在某些人群中，可能需要加强社区和门诊感染控制策略，以防止CA-MRSA交叉传播和感染。
Background. The epidemic of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has had a disproportionate impact on patients with human immunodeficiency virus (HIV).Methods. We evaluated CA-MRSA colonization burden (number of colonized sites per total number sampled) among HIV-infected and HIV-negative inpatients within 72 hours of hospitalization. From March 2011 through April 2012, we obtained cultures from nasal and extranasal sites (throat, axilla, inguinal, perirectal, and chronic wound if present) and collected risk factor data.Results. Of 745 patients (374 HIV-infected, 371 HIV-negative), 15.7% were colonized with CA-MRSA at any site: 20% of HIV and 11% of HIV-negative patients (relative prevalence = 1.8, P = .002). HIV-infected patients had a higher prevalence of nasal, extranasal, and exclusive extranasal colonization as well as higher colonization burden. Perirectal and inguinal areas were the extranasal sites most frequently colonized, and 38.5% of colonized patients had exclusive extranasal colonization. Seventy-three percent of isolates were identified as USA300. Among HIV-infected patients, male sex, younger age, and recent incarceration were positively associated whereas Hispanic ethnicity was negatively associated with higher colonization burden. Among HIV-negative patients, temporary housing (homeless, shelter, or substance abuse center) was the only factor associated with higher colonization burden. Predictors of USA300 included HIV, younger age, illicit drug use, and male sex; all but 1 colonized individual with current or recent incarceration carried USA300.Conclusions. HIV-infected patients were more likely to have a higher CA-MRSA colonization burden and carry USA300. In certain populations, enhanced community and outpatient-based infection control strategies may be needed to prevent CA-MRSA cross-transmission and infection.