Clinical predictors of the leading pathogens in human immunodeficiency virus-infected adults with community-onset bacteremia in the emergency department: The importance of transmission routes

Nasal colonization of methicillin-resistant Staphylococcus aureus in HIV-infected patients at the Cape Coast Teaching Hospital, Ghana

Methicillin-resistant Staphylococcus aureus (MRSA) continues to be associated with outbreaks in communities (CA-MRSA) and hospitals (HA-MRSA). MRSA isolates are known to be resistant to all beta-lactam antibiotics including methicillin. Moreover, HIV-infected individuals are highly at risk of CA-MRSA due to their weaker immune system. It is therefore important to keep surveillance of the prevalence. Our study aims at determining the prevalence of Staphylococcus aureus and MRSA among HIV-infected participants, the bacteria’s associations, and their antibiotic susceptibility patterns. A cross-sectional study was conducted and nasal swabs from 657 participants attending the HIV clinic at the Cape Coast Teaching Hospital were taken following guidelines. Confirmed S. aureus isolates were taken through antibiotic susceptibility tests per the Kirby–Bauer method, and isolates that were resistant to cefoxitin were considered to be MRSA. The carriage prevalence of S. aureus and MRSA was 44.7% and 8.2%, respectively, among the HIV-infected individuals. There was a significant association between hospitalization and MRSA colonization (p = 0.002), but not S. aureus colonization (p = 0.266). Significant association was also observed between age (p = 0.001), sex (p = 0.0001), and S. aureus colonization. Similarly, differences in age groups (p = 0.001), sex (p = 0.02), and MRSA colonization were statistically significant (p = 0.001). High percentage resistance was exhibited by the isolates to most of the antibiotics. However, this study did not record vancomycin resistance among the MRSA strains. The study showed high colonization of S. aureus and MRSA in HIV-infected patients, which was mostly associated with the age and sex of the individuals.

Talaromyces marneffei is the Persistent Overwhelming Bloodstream Infection Pathogen Among HIV Inpatients in Fujian, China

Purpose

This study aimed to investigate the epidemiology and etiological spectrums of BSI in Fujian over the past 6 years in the post antiretroviral treatment (ART) era.

Methods

A retrospective, observational study was conducted to include positive BSI inpatients with HIV between September 2015 and August 2021 in Mengchao Hepatobiliary Hospital of Fujian Medical University, the largest designated HIV/AIDS care hospital in Fujian, China. Demographic data and laboratory data including gender, age, blood cell counts, biochemistry results, CD4 and CD8 cell counts, HIV-RNA loads, pathogen isolates, procalcitonin (PCT) levels and c-reactive protein (CRP) levels were collected. Continuous variables were expressed as median (range) and Kruskal–Wallis or Mann–Whitney test was used to analyze the differences between groups. Categorical data were expressed as numbers (percentage) and the differences between groups were analyzed by Pearson’s chi-squared test.

Results

In total, 3681 HIV inpatients with blood culture data were included and 683 strains identified from 646 inpatients were further analyzed. The median age of patients was 38 years and male accounted for 86.84%. The pooled prevalence of BSI was 18.55% (12.01%–22.36% during the six-year period). The overall isolated rate of Talaromyces marneffei (TM) in blood culture was 12.42% (8.3%–15.00% during the study period). TM was the persistent dominant BSI pathogen from 2015 to 2021 (accounting for 63.04% to 71.43%), followed by Cryptococcus neoformans (responsible for 10.00% to 20.83%). Compared to patients with other organisms BSI, those with TM BSI were younger and had lower CD4 counts, WBC counts, HB and CRP level, but higher HIVRNA loads.

Conclusion

BSI is still a major problem in the post ART era in hospitalized patients with HIV/AIDS in Fujian, China. TM is the predominant pathogen. This underlines the importance of an early diagnosis of opportunistic pathogen to avoid BSI in HIV-infected populations with a low immune status.

Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization among human immunodeficient virus-infected outpatients in Taiwan: oral Candida colonization as a comparator

Human immuodeficency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART) and community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) have increased in recent years in Taiwan. This study was undertaken to determine the prevalence of and risk factors for nasal and oral S. aureus and MRSA colonization among contemporary HIV-infected populations. Clinical variables for S. aureus and MRSA colonization among HIV-infected outpatients from three hospitals were analyzed and compared with those for oral Candida colonization. Genetic characteristics of MRSA isolates were analyzed. A total of 714 patients were screened for nasal S. aureus colonization, and a subset of 457 patients were also screened for oral S. aureus colonization. Of all patients, 79.4% were receiving HAART, and their mean CD4 count was 472 cells/mm³. The colonization rates in the oral cavity, nasal cavity, and at either site were 18.8%, 31.7%, and 36.8%, respectively, for S. aureus, and 3.1%, 4.4%, and 5.5%, respectively, for MRSA. These rates were all much lower than the previously reported rate of oral Candida colonization (52.4%). By multivariate analysis, a suppressed viral load (<200 copies/mL) protected against oral S. aureus, MRSA, and Candida colonization, and recent use of antibacterial agents protected against oral and nasal S. aureus colonization. Recent incarceration increased the risk of nasal MRSA colonization, while recent hospitalization, tuberculosis, older age, and intravenous drug use increased the risk of oral Candida colonization. Candida spp. did not augment S. aureus or MRSA colonization in the oral cavity. Most of the 41 MRSA isolates recovered belonged to the SCCmec IV/pvl-negative (51.2%) and V_T/pvl-positive (26.8%) ST59 local prevalent CA-MRSA clones. Distinct carriage rates demonstrated here suggested that mucosal immunity against colonization might differ in terms of microbes and sites. A decreased risk in oral carriage of MRSA and Candida might be a benefit of HAART.