16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

INCREASING RATES OF COMMUNITY-ACQUIRED MRSA INFECTIONS AMONG HIV-INFECTED PERSONS

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. MoAb0304

Crum-Cianflone N.¹, Hale B.², Burgi A.¹, Utz G.², Truett A.², Chun H.², Bavaro M.², TriService AIDS Clinical Consortium
¹TriService AIDS Clinical Consortium, San Diego, United States, ²Naval Medical Center San Diego, San Diego, United States

BACKGROUND: Community-acquired (CA)-MRSA rates are rapidly increasing in the general population, but there are few data regarding the rates among HIV-infected patients and the risk factors in this population.

METHODS We assessed the incidence of CA-MRSA infections from 1993-2005 in a large HIV clinic. We collected data on all patients with CA-MRSA infections receiving care at our facility. Cases were defined as patients with a positive MRSA culture without a history of recent (<1 year) hospitalization. We compared HIV patients with MRSA to HIV patients without MRSA in terms of demographics, antibiotic and antiretroviral history, CD4 counts, viral loads, and STDs using Fisher’s exact and rank-sum testing. A backward stepwise multivariate logistic regression model was constructed to determine risk factors for CA-MRSA.

RESULTS: Among 425 HIV patients, 25 (5.9%) developed CA-MRSA. All cases occurred after 2002, with a 17-fold increase from 2003 to 2005 (Chi-square test of trend 15.7, p<0.001). The annual incidence in 2005 among HIV patients was 40 cases/1000 person-years compared to 741 cases/325,000 (or 2.28/1000) among HIV-negative persons (18 fold higher rate). All HIV-infected patients developed soft-tissue infections, 16% required hospitalization, 67% had a positive nares cultures, 0% were taking Septra prophylaxis, and 56% HAART. Sixteen percent had relapsing MRSA infections despite appropriate initial antibiotics. In the univariate analyses, lower current CD4 count, CDC stage C, history of syphilis, and B-lactam antibiotics in the past year were predictive of MRSA; there were no associations with demographics, diabetes, or HAART. In the multivariate analysis, recent use of B-lactam antibiotics (p=0.04) and syphilis (p=0.02) predicted CA-MRSA infections in HIV patients.

CONCLUSIONS: Community-acquired MRSA infections are rapidly increasing among HIV-infected patients. HIV patients have a 18-fold higher risk for CA-MRSA than the general population. Risk factors for CA-MRSA include recent use of B-lactam antibiotics and high-risk sexual activity as demonstrated by syphilis infection.

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2006-08-13
MoAb0304

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