Journal Article

Community-Associated Methicillin-Resistant <i>Staphylococcus aureus</i> and HIV: Intersecting Epidemics

Kyle J. Popovich, Robert A. Weinstein, Alla Aroutcheva, Thomas Rice and Bala Hota

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 7, pages 979-987
Published in print April 2010 | ISSN: 1058-4838
Published online April 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/651076
Community-Associated Methicillin-Resistant Staphylococcus aureus and HIV: Intersecting Epidemics

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Background

Single-site studies have suggested a link between human immunodeficiency virus (HIV) and community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA).

Methods

Population-level incidence of HIV-infected patients with CA-MRSA versus community-associated methicillin-susceptible S. aureus (CA-MSSA) infection was assessed in the Cook County Health and Hospitals System (CCHHS), a multi-hospital and ambulatory care center. Rates in zip codes, including those with a high density of individuals with prior incarceration (ie, high-risk zip codes), were calculated. We did a nested case-control analysis of hospitalized HIV-infected patients with S. aureus skin and soft-tissue infections (SSTIs).

Results

In CCHHS, the incidence of CA-MRSA SSTIs was 6-fold higher among HIV-infected patients than it was among HIV-negative patients (996 per 100,000 HIV-infected patients vs 157 per 100,000 other patients; P <.001 ). The incidence of CA-MRSA SSTIs among HIV-infected patients significantly increased from 2000–2003 (period 1) to 2004–2007 (period 2) (from 411 to 1474 cases per 100,000 HIV-infected patients; relative risk [RR], 3.6; P <.001 ), with cases in period 1 clustering in an area 6.3 km in diameter (P = .035 ) that overlapped high-risk zip codes. By period 2, CA-MRSA SSTIs among HIV-infected patients were spread throughout Cook County. USA300 was identified as the predominant strain by pulsed-field gel electrophoresis (accounting for 86% of isolates). Among hospitalized HIV-infected patients, the incidence of CA-MRSA increased significantly from period 1 to period 2 (from 190 to 779 cases per 100,000 HIV-infected patients; RR, 4.1; P <.001). Risks for CA-MRSA by multivariate analysis were residence in alternative housing (eg, shelters), residence in high-risk zip codes, younger age, and infection in period 2.

Conclusions

HIV-infected patients are at markedly increased risk for CA-MRSA infection. This risk may be amplified by overlapping community networks of high-risk patients that may be targets for prevention efforts.

Journal Article.  5641 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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