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Boison D, Akwetey SA, Osei SA, Kelechi S, Barnie PA. Nasal colonization of methicillin-resistant Staphylococcus aureus in HIV-infected patients at the Cape Coast Teaching Hospital, Ghana. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.976567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Kapali S, Pokhrel A, Bastola A, Tuladhar R, Joshi DR. Methicillin-resistant Staphylococcus aureus nasal colonization in people living with HIV and healthy people in Kathmandu, Nepal. Future Sci OA 2022; 8:FSO769. [PMID: 35070354 PMCID: PMC8765096 DOI: 10.2144/fsoa-2021-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/26/2021] [Indexed: 11/26/2022] Open
Abstract
AIM This study aimed to compare methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in people living with HIV (PLHIV) and healthy people from Kathmandu. METHODS MRSA isolated from 400 nasal swabs was screened using a cefoxitin disc and confirmed by the presence of the mecA gene. RESULTS MRSA nasal carriers among the PLHIV and control cohorts were 3.5% (7 out of 200) and 5.0% (10 out of 200), respectively. All the MRSA from PLHIV and most of MRSA from healthy controls were PVL positive. Longer duration of antiretroviral therapy significantly reduces the risk of MRSA nasal colonization in PLHIV. CONCLUSION There is no significant difference in MRSA nasal colonization in PLHIV and healthy controls in this study region.
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Affiliation(s)
- Samjhana Kapali
- Central Department of Microbiology, Institute of Science & Technology, Tribhuvan University, Kathmandu, 44613, Nepal
| | - Anil Pokhrel
- Central Department of Microbiology, Institute of Science & Technology, Tribhuvan University, Kathmandu, 44613, Nepal
| | - Anup Bastola
- Department of Dermatology & Sexually Transmitted Infections, Sukraraj Tropical & Infectious Disease Hospital, Kathmandu, 44600, Nepal
| | - Reshma Tuladhar
- Central Department of Microbiology, Institute of Science & Technology, Tribhuvan University, Kathmandu, 44613, Nepal
| | - Dev Raj Joshi
- Central Department of Microbiology, Institute of Science & Technology, Tribhuvan University, Kathmandu, 44613, Nepal
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Hu X, Hu K, Liu Y, Zeng L, Hu N, Chen X, Zhang W. Risk factors for methicillin-resistant Staphylococcus aureus colonization and infection in patients with human immunodeficiency virus infection: A systematic review and meta-analysis. J Int Med Res 2022; 50:3000605211063019. [PMID: 35040345 PMCID: PMC8777361 DOI: 10.1177/03000605211063019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To investigate the potential factors affecting methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in patients with human immunodeficiency virus (HIV) infection. METHODS A systematic search of publications listed in electronic from inception up to August 2020 was conducted. A random-effects model was used to calculate odds ratio (OR) with 95% confidence interval (CI). RESULTS A total of 31 studies reporting 1410 MRSA events in 17 427 patients with HIV infection were included. Previous hospitalization (OR 1.80; 95% CI 1.37, 2.36), previous antibiotic therapy (OR 2.69; 95% CI 2.09, 3.45), CD4+ count (OR 1.79; 95% CI 1.41, 2.28), Centers for Disease Control and Prevention classification of stage C (OR 2.66; 95% CI 1.80, 3.93), skin lesions (OR 2.02; 95% CI 1.15, 3.55), intravenous device use (OR 2.61; 95% CI 1.59, 4.29) and an MRSA colonization history (OR 6.30; 95% CI 2.50, 15.90) were significantly associated with an increased risk of MRSA colonization and infection. Antiretroviral therapy (OR 0.71; 95% CI 0.50, 0.99) and current antibiotic use (OR 0.13; 95% CI 0.05, 0.32) were significantly associated with a reduced risk of MRSA colonization and infection. CONCLUSION MRSA colonization and infection in HIV-infected patients is associated with a number of risk factors.
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Affiliation(s)
- Xuefei Hu
- Clinical Laboratory of the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Keao Hu
- Department of Urology, The First Clinical College of Nanchang University Medical College, Nanchang, Jiangxi Province, China
| | - Yanling Liu
- Clinical Laboratory of the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Lingbing Zeng
- Clinical Laboratory of the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Niya Hu
- Clinical Laboratory of the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Xiaowen Chen
- Clinical Laboratory of the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Wei Zhang
- Department of Respiration, 117970First Affiliated Hospital of Nanchang University, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
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Panigrahy A, Sinha S, Das BK, Kapil A, Vishnubhatla S, Dhawan B. Staphylococcus aureus colonisation in HIV-infected patients: Incidence, risk factors and subsequent skin- and soft-tissue infections. Indian J Med Microbiol 2020; 38:444-447. [PMID: 33154260 DOI: 10.4103/ijmm.ijmm_20_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We evaluated the incidence and risk factors of Staphylococcus aureus colonisation in 300 treatment-naïve HIV patients. Swabs from anterior nares and pharynx were cultured. Eighty-eight patients (29.3%) were colonised with S. aureus (47.7% nasal, 23.8% pharyngeal and 28.5% at both sites), which yielded 112 isolates. Methicillin-resistant S. aureus was detected in 25.9% (29/112) of isolates. Panton-Valentine leucocidin gene was present in 18.8% (21/112) of isolates. Multiple logistic regression analysis identified CD4 count <200 cells/mm3, public bath use, alcohol intake and other sexually transmitted infections as independent predictors for S. aureus colonisation. On follow-up, 22.7% of patients with S. aureus colonisation developed skin- and soft-tissue infections. Strategies for behavioural changes would be helpful in controlling S. aureus colonisation and subsequent infection.
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Affiliation(s)
- Aashirwad Panigrahy
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bimal Kumar Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Benu Dhawan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Changing antibiotic resistance profile of Staphylococcus aureus isolated from HIV patients (2012-2017) in Southern India. J Infect Public Health 2019; 13:75-79. [PMID: 31402312 DOI: 10.1016/j.jiph.2019.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/20/2019] [Accepted: 06/16/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Emergence of multidrug-resistant and methicillin-resistant Staphylococcus aureus (MRSA) infections in HIV patients limit the treatment options and challenge the clinical management of infections. The periodic monitoring of S. aureus infections and its drug resistance profile in HIV patients are of paramount importance in clinical management. MATERIALS AND METHODS A total of 7204 clinical specimens from HIV patients from 2012 to 2017 were processed for the isolation of S. aureus strains using conventional culture techniques and cultures were identified using standard biochemical test. Antibiotic susceptibility of S. aureus strains was tested by Kirby-Bauer disk diffusion method. RESULTS A total of 380 (5.3%) S. aureus strains were isolated from HIV patients in the study period. High percentage of S. aureus strains were isolates from urine (69.5%) specimen and 58.4% of S. aureus infections were noted among hospitalized patients. Antibiotic susceptibility profile reveals S. aureus was highly resistant to penicillin (95.2%) followed by cephalexin (84.6%). Methicillin resistance was highly observed in the year 2017 (86%) and the rate of MRSA steadily increasing from 51.8% in 2012 to 86% in 2017. Significant increase of S. aureus infections (35%; p<0.001) and MRSA (76%; p=0.0007) were observed in the year 2016. CONCLUSIONS This study reports the increasing trends of S. aureus infections and MRSA among HIV patients from Southern India. Multidrug-resistance profile of S. aureus could complicate the selection of proper antibiotic regimens and time cure of HIV patients.
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Sabbagh P, Riahi SM, Gamble HR, Rostami A. The global and regional prevalence, burden, and risk factors for methicillin-resistant Staphylococcus aureus colonization in HIV-infected people: A systematic review and meta-analysis. Am J Infect Control 2019; 47:323-333. [PMID: 30170767 DOI: 10.1016/j.ajic.2018.06.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important opportunistic pathogens in HIV+ patients, resulting in considerable morbidity and mortality. METHODS The MEDLINE, Scopus, Web of Science, and EMBASE databases were comprehensively searched for studies that investigated the prevalence of MRSA colonization in HIV+ patients. We used a random effects model to calculate pooled prevalence estimates with 95% confidence intervals (CI) and analyzed data based on World Health Organization regions. RESULTS Among 9,772 records identified, 69 were included in the meta-analysis, comprising 30,050 HIV+ patients from 21 countries. We estimated the pooled worldwide prevalence of MRSA in people living with HIV to be 7% (95% CI 5%-9%, 1,623/30,050), with the highest prevalence in Southeast Asia (16%, 95% CI 9%-24%) and the region of the Americas (10%; 95% CI 7%-13%) and lowest prevalence in the European region (1%; 95% CI 0%-1%). Globally, we estimated approximately 2,659,000 (95% CI 1,835,000-3,303,000) HIV+ patients with colonized MRSA. Potential risk factors for MRSA colonization in HIV+ patients included previous MRSA infection (OR, 7.5; 95% CI, 3.91-14.37), hospitalization in the past year (OR, 1.87; 95% CI 1.11-3.16), and use of antibiotics (OR, 2.52; 95% CI 1.39-4.58). CONCLUSIONS Our findings emphasize the importance of routine screening for MRSA among all HIV+ patients throughout the world, especially in regions that have a high burden of disease.
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Methicillin-resistant Staphylococcus aureus colonisation: epidemiological and molecular characteristics in an acute-care tertiary hospital in Singapore. Epidemiol Infect 2018; 146:1785-1792. [PMID: 30019657 DOI: 10.1017/s0950268818001966] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Current knowledge of methicillin-resistant Staphylococcus aureus (MRSA) colonisation in relation to epidemiological characteristics is incomplete. We conducted a cross-sectional study at an acute-care tertiary infectious diseases hospital of MRSA isolates identified through routine surveillance from January 2009 to December 2011. We randomly selected 205 MRSA isolates (119 inpatients) from 798 isolates (427 inpatients) for molecular profiling using multilocus sequence typing. Multilevel multinomial logistic regression was used to estimate odds ratio (OR) assessing the predilection of MRSA strains for anatomic sites, and associations of strains with human immunodeficiency virus (HIV) infection. The most frequent sequence types (STs) were 239, 22 and 45. The proportion of ST22 increased over the sampling period, replacing ST239 as the dominant lineage. However, ST239 remained the most prevalent among HIV-seropositive individuals who were six times more likely to be colonised with this strain than non-HIV patients (adjusted OR (aOR) 6.44, 95% confidence interval (CI) 1.94-21.36). ST45 was >24 times more likely to be associated with perianal colonisation than in the nares, axillae and groin sites (aOR 24.20, 95% CI 1.45-403.26). This study underlines the clonal replacement of MRSA in Singapore as previously reported but revealed, in addition, key strain differences between HIV-infected and non-infected individuals hospitalised in the same environment.
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Sullivan SB, Kamath S, McConville TH, Gray BT, Lowy FD, Gordon PG, Uhlemann AC. Staphylococcus epidermidis Protection Against Staphylococcus aureus Colonization in People Living With Human Immunodeficiency Virus in an Inner-City Outpatient Population: A Cross-Sectional Study. Open Forum Infect Dis 2016; 3:ofw234. [PMID: 28018932 PMCID: PMC5170490 DOI: 10.1093/ofid/ofw234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/26/2016] [Indexed: 01/22/2023] Open
Abstract
Background. People living with human immunodeficiency virus (PLWH) have been disproportionally affected by methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection, in particular by clones USA300 and USA500. However, the contribution of epidemiological, bacterial, and immunological risk factors to the excess of S aureus in PLWH remain incompletely understood. Methods. In this cross-sectional study, we determined the prevalence and molecular epidemiology of S aureus colonization in 93 PLWH attending an urban human immunodeficiency virus (HIV) clinic. Participants completed a structured interview assessing demographic information and risk factors for MRSA. Swabs were obtained from the nose, throat, and groin and cultured for S aureus and Staphylococcus epidermidis. Results. Most participants had well controlled HIV infection (89, 96% CD4 >200). Thirty-six (39%) individuals were colonized with S aureus at 1 or more body sites, including 6 (6%) with MRSA. Regular gym use was a risk factor for S aureus but not MRSA carriage. In contrast, S epidermidis was present in almost all individuals (n = 84, 90%), predominantly in the nares (n = 66, 71%). Using generalized estimating equation models, we observed that the odds of S aureus colonization were significantly and drastically reduced when S epidermidis was detected (P = .0001). After controlling for site, gender, and age, we identified that the odds of S aureus colonization were 80% less if S epidermidis was present (adjusted odds ratio, 0.20; 95% confidence interval, .09–.45; P < .0001). Conclusions. Taken together, we observed a lower prevalence of S aureus and MRSA colonization than has been previously reported in PLWH. In this cohort, colonization with S epidermidis was protective against S aureus colonization.
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Affiliation(s)
| | - Suneel Kamath
- Departments ofMedicine and; Northwestern Memorial Hospital, Chicago, Illinois
| | | | | | - Franklin D Lowy
- Departments ofMedicine and; Pathology, Columbia University Medical Center, New York
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Gebremedhn G, Gebremariam TT, Wasihun AG, Dejene TA, Saravanan M. Prevalence and risk factors of methicillin-resistant Staphylococcus aureus colonization among HIV patients in Mekelle, Northern Ethiopia. SPRINGERPLUS 2016; 5:877. [PMID: 28443214 PMCID: PMC5396476 DOI: 10.1186/s40064-016-2613-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 06/17/2016] [Indexed: 12/02/2022]
Abstract
HIV-positive individuals are at higher risk of Methicillin Resistant
Staphylococcus aureus (MRSA) colonization and
its related infection. There is limited data in the nation on the prevalence and
risk factors of MRSA colonization among HIV patients. The aim of this study was to
address the existing knowledge gap. Cross sectional study was carried out from
September 2014 to February 2015 in three selected health centers and one general
hospital. A standardized questionnaire was developed for collection of
socio-demographic and clinical data. A total of 498 Nasal and throat swabs (two for
each patient) were collected from 249 patients, transported and processed using
standard bacteriological procedures. Data was analyzed using Chi square
(X2) test and associated risk factors were determined.
P < 0.05 was considered statistically
significant. Out of 249 study participants, S.
aureus was isolated from 81 (32.5 %) patients, with MRSA colonization
rate of 6 (2.4 %). MRSA isolates were resistant to Ciprofloxacin and
trimethoprim-sulphamethoxazole (16.7 % each), clindamycin (33.3 %) and erythromycin
(50 %). However, all MRSA isolates were 100 % sensitive to Amikacin. History of
hospitalization, percutaneous device usage, patients with a household member’s
hospitalization and low CD4 count (<200
cells/mm3) were significantly associated with S. aureus colonization (p < 0.05).
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Affiliation(s)
- Goyitom Gebremedhn
- Department of Medical Microbiology and Immunology, Institute of Biomedical Science, College of Health Sciences, Mekelle University, 1871 Mekelle, Ethiopia.,Tigray Regional State Health Bureau, Mekelle, Ethiopia
| | - Tewelde Tesfay Gebremariam
- Department of Medical Microbiology and Immunology, Institute of Biomedical Science, College of Health Sciences, Mekelle University, 1871 Mekelle, Ethiopia
| | - Araya Gebreyesus Wasihun
- Department of Medical Microbiology and Immunology, Institute of Biomedical Science, College of Health Sciences, Mekelle University, 1871 Mekelle, Ethiopia
| | - Tsehaye Asmelash Dejene
- Department of Medical Microbiology and Immunology, Institute of Biomedical Science, College of Health Sciences, Mekelle University, 1871 Mekelle, Ethiopia
| | - Muthupandian Saravanan
- Department of Medical Microbiology and Immunology, Institute of Biomedical Science, College of Health Sciences, Mekelle University, 1871 Mekelle, Ethiopia
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Isolation of Methicillin-Resistant Staphylococcus aureus (MRSA) from HIV Patients Referring to HIV Referral Center, Shiraz, Iran, 2011-2012. IRANIAN JOURNAL OF MEDICAL SCIENCES 2015; 40:526-30. [PMID: 26538782 PMCID: PMC4628144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Extension of drug resistant Staphylococcus aureus strains is one of the problems of modern society. Presence of methicillin-resistant Staphylococcus aureus (MRSA) in HIV-infected individuals is an important cause of severe infections. Therefore, the main goal of this study was to determine the prevalence rate of MRSA carriage rate among HIV patients referring to the Shiraz HIV referral center (Shiraz, Iran) during 2011-2012. Nasal swabs were obtained from HIV positive patients and were cultured on differential and selective media to isolate Staphylococcus aureus, which was confirmed by standard biochemical tests. For isolation of MRSA isolates, bacterial suspensions were cultured on Muller-Hinton Agar containing NaCl and Oxacillin. Finally, data were analyzed by the SPSS software. Of 180 HIV patients, MRSA was isolated from nasal cavity of 23 (12.8%) patients. Most of the isolates were recovered from male subjects who were under 40 years old. No variables such as skin disease, history of hospitalization or infectious disease had significant association with the MRSA colonization rate. The presence of MRSA isolates in the nasal cavity of HIV patients in such a rate warns us about the potential spreading of MRSA among HIV patients in our society and emphasizes on establishing better prevention strategies.
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Win MK, Soliman TAA, Lee LK, Wong CS, Chow A, Ang B, Roman CL, Leo YS. Review of a two-year methicillin-resistant Staphylococcus aureus screening program and cost-effectiveness analysis in Singapore. BMC Infect Dis 2015; 15:391. [PMID: 26419926 PMCID: PMC4587866 DOI: 10.1186/s12879-015-1131-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 09/18/2015] [Indexed: 12/30/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) poses an increasingly large disease and economic burden worldwide. The effectiveness of screening programs in the tropics is poorly understood. The aims of this study are: (i) to analyze the factors affecting MRSA colonization at admission and acquisition during hospitalization and (ii) to evaluate the cost-effectiveness of a screening program which aims to control MRSA incidence during hospitalization. Methods We conducted a retrospective case–control study of patients admitted to the Communicable Disease Centre (CDC) in Singapore between Jan 2009 and Dec 2010 when there was an ongoing selective screening and isolation program. Risk factors contributing to MRSA colonization on admission and acquisition during hospital stay were evaluated using a logistic regression model. In addition, a cost-effectiveness analysis was conducted to determine the cost per disability-adjusted life year (DALY) averted due to implementing the screening and isolation program. Results The average prevalence rate of screened patients at admission and the average acquisition rate at discharge during the study period were 12.1 and 4.8 % respectively. Logistic regression models showed that older age (adjusted odds ratio (OR) 1.03, 95 % CI 1.02–1.04, p < 0.001) and dermatological conditions (adjusted OR 1.49, 95 % CI 1.11–1.20, p = 0.008) were independently associated with an increased risk of MRSA colonization at admission. Age (adjusted OR 1.02, 95 % CI 1.01–1.03, p = 0.002) and length of stay in hospital (adjusted OR 1.04, 95 % CI 1.03–1.06, p < 0.001) were independent factors associated with MRSA acquisition during hospitalization. The screening and isolation program reduced the acquisition rate by 1.6 % and was found to be cost saving. For the whole study period, the program cost US$129,916, while it offset hospitalization costs of US$103,869 and loss of productivity costs of US$50,453 with −400 $/DALY averted. Discussion This study is the first to our knowledge that evaluates the cost-effectiveness of screeningand isolation of MRSA patients in a tropical country. Another unique feature of the analysis is the evaluationof acquisition rates among specific types of patients (dermatological, HIV and infectious disease patients)and the comparison of the cost-effectiveness of screening and isolation between them. Conclusions Overall our results indicate high MRSA prevalence that can be cost effectively reduced by selective screening and isolation programs in Singapore.
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Affiliation(s)
- Mar-Kyaw Win
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
| | | | - Linda Kay Lee
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Chia Siong Wong
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Angela Chow
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Brenda Ang
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Carrasco L Roman
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore.
| | - Yee-Sin Leo
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore. .,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
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Weintrob A, Bebu I, Agan B, Diem A, Johnson E, Lalani T, Wang X, Bavaro M, Ellis M, Mende K, Crum-Cianflone N. Randomized, Double-Blind, Placebo-Controlled Study on Decolonization Procedures for Methicillin-Resistant Staphylococcus aureus (MRSA) among HIV-Infected Adults. PLoS One 2015; 10:e0128071. [PMID: 26018036 PMCID: PMC4446345 DOI: 10.1371/journal.pone.0128071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 04/21/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND HIV-infected persons have increased risk of MRSA colonization and skin and soft-tissue infections (SSTI). However, no large clinical trial has examined the utility of decolonization procedures in reducing MRSA colonization or infection among community-dwelling HIV-infected persons. METHODS 550 HIV-infected adults at four geographically diverse US military HIV clinics were prospectively screened for MRSA colonization at five body locations every 6 months during a 2-year period. Those colonized were randomized in a double-blind fashion to nasal mupirocin (Bactroban) twice daily and hexachlorophene (pHisoHex) soaps daily for 7 days compared to placeboes similar in appearance but without specific antibacterial activity. The primary endpoint was MRSA colonization at 6-months post-randomization; secondary endpoints were time to MRSA clearance, subsequent MRSA infections/SSTI, and predictors for MRSA clearance at the 6-month time point. RESULTS Forty-nine (9%) HIV-infected persons were MRSA colonized and randomized. Among those with 6-month colonization data (80% of those randomized), 67% were negative for MRSA colonization in both groups (p = 1.0). Analyses accounting for missing 6-month data showed no significant differences could have been achieved. In the multivariate adjusted models, randomization group was not associated with 6-month MRSA clearance. The median time to MRSA clearance was similar in the treatment vs. placebo groups (1.4 vs. 1.8 months, p = 0.35). There was no difference on subsequent development of MRSA infections/SSTI (p = 0.89). In a multivariable model, treatment group, demographics, and HIV-specific factors were not predictive of MRSA clearance at the 6-month time point. CONCLUSION A one-week decolonization procedure had no effect on MRSA colonization at the 6-month time point or subsequent infection rates among community-dwelling HIV-infected persons. More aggressive or novel interventions may be needed to reduce the burden of MRSA in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT00631566.
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Affiliation(s)
- Amy Weintrob
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Infectious Disease Clinic, Walter Reed National Military Medical Center, Bethesda, MD, United States of America
| | - Ionut Bebu
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Brian Agan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Alona Diem
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, CA, United States of America
| | - Erica Johnson
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Infectious Disease Service, San Antonio Military Medical Center, San Antonio, TX, United States of America
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Infectious Disease Clinic, Naval Medical Center, Portsmouth, VA, United States of America
| | - Xun Wang
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Mary Bavaro
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, CA, United States of America
| | - Michael Ellis
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Infectious Disease Service, San Antonio Military Medical Center, San Antonio, TX, United States of America
| | - Nancy Crum-Cianflone
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
- Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, CA, United States of America
- * E-mail:
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Reinato LAF, Pio DPM, Lopes LP, Pereira FMV, Lopes AER, Gir E. Nasal colonization with Staphylococcus aureus in individuals with HIV/ AIDS attended in a Brazilian teaching hospital. Rev Lat Am Enfermagem 2015; 21:1235-9. [PMID: 24402339 DOI: 10.1590/0104-1169.3067.2359] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 08/21/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to evaluate the prevalence of nasal colonization with Staphylococcus aureus in individuals with HIV/AIDS under inpatient treatment in a teaching hospital in the state of São Paulo (Brazil). METHOD a cross-sectional study undertaken in two units specialized in attending people living with HIV/AIDS, in the period August 2011 - July 2012. Socio-demographic and clinical data was collected through individual interviews and from the medical records; samples of nasal secretion were collected with Stuart swabs on the first day of inpatient treatment. Ethical aspects were respected. RESULT of the 229 individuals with HIV/AIDS hospitalized in this period, 169 participated in the study, with Staphylococcus aureus being identified in the culture tests of 46 (27.2%) of the individuals, resistance to oxacillin being evidenced in 10 (21.8%) participants. CONCLUSION the results of the research indicate that the prevalence of colonization with Staphylococcus aureus in individuals with HIV/AIDS in the specialized units was considered relevant, possibly contributing to future investigations and, moreover, to the implementation of measures to prevent and control this pathogen in this population.
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Affiliation(s)
| | | | - Letícia Pimenta Lopes
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão PretoSP, Brazil
| | | | - Ana Elisa Ricci Lopes
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão PretoSP, Brazil
| | - Elucir Gir
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão PretoSP, Brazil
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Crum-Cianflone NF, Wang X, Weintrob A, Lalani T, Bavaro M, Okulicz JF, Mende K, Ellis M, Agan BK. Specific Behaviors Predict Staphylococcus aureus Colonization and Skin and Soft Tissue Infections Among Human Immunodeficiency Virus-Infected Persons. Open Forum Infect Dis 2015; 2:ofv034. [PMID: 26380335 PMCID: PMC4567094 DOI: 10.1093/ofid/ofv034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/28/2015] [Indexed: 01/30/2023] Open
Abstract
Background. Few data exist on the incidence and risk factors of Staphylococcus aureus colonization and skin and soft tissue infections (SSTIs) among patients infected with human immunodeficiency virus (HIV). Methods. Over a 2-year period, we prospectively evaluated adults infected with HIV for incident S aureus colonization at 5 body sites and SSTIs. Cox proportional hazard models using time-updated covariates were performed. Results. Three hundred twenty-two participants had a median age of 42 years (interquartile range, 32-49), an HIV duration of 9.4 years (2.7-17.4), and 58% were on highly active antiretroviral therapy (HAART). Overall, 102 patients (32%) became colonized with S aureus with an incidence rate of 20.6 (95% confidence interval [CI], 16.8-25.0) per 100 person-years [PYs]. Predictors of colonization in the final multivariable model included illicit drug use (hazard ratios [HR], 4.26; 95% CI, 1.33-13.69) and public gym use (HR 1.66, 95% CI, 1.04-2.66), whereas antibacterial soap use was protective (HR, 0.50; 95% CI, 0.32-0.78). In a separate model, perigenital colonization was associated with recent syphilis infection (HR, 4.63; 95% CI, 1.01-21.42). Fifteen percent of participants developed an SSTI (incidence rate of 9.4 cases [95% CI, 6.8-12.7] per 100 PYs). Risk factors for an SSTI included incident S aureus colonization (HR 2.52; 95% CI, 1.35-4.69), public shower use (HR, 2.59; 95% CI, 1.48-4.56), and hospitalization (HR 3.54; 95% CI, 1.67-7.53). The perigenital location for S aureus colonization was predictive of SSTIs. Human immunodeficiency virus-related factors (CD4 count, HIV RNA level, and HAART) were not associated with colonization or SSTIs. Conclusions. Specific behaviors, but not HIV-related factors, are predictors of colonization and SSTIs. Behavioral modifications may be the most important strategies in preventing S aureus colonization and SSTIs among persons infected with HIV.
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Affiliation(s)
- Nancy F. Crum-Cianflone
- Infectious Disease Clinical Research Program
- Infectious Disease Clinic, Naval Medical Center San Diego, California
| | - Xun Wang
- Infectious Disease Clinical Research Program
- Henry M. Jackson Foundation for Advancement of Military Medicine, Bethesda, Maryland
| | - Amy Weintrob
- Infectious Disease Clinical Research Program
- Infectious Disease Clinic, Walter Reed Army Medical Center, Washington, District of Columbia
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program
- Infectious Disease Clinic, Naval Medical Center Portsmouth, Virginia
| | - Mary Bavaro
- Infectious Disease Clinical Research Program
- Infectious Disease Clinic, Naval Medical Center San Diego, California
| | | | - Katrin Mende
- Infectious Disease Clinical Research Program
- Henry M. Jackson Foundation for Advancement of Military Medicine, Bethesda, Maryland
| | - Michael Ellis
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Brian K. Agan
- Infectious Disease Clinical Research Program
- Henry M. Jackson Foundation for Advancement of Military Medicine, Bethesda, Maryland
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Kotpal R, S KP, Bhalla P, Dewan R, Kaur R. Incidence and Risk Factors of Nasal Carriage of Staphylococcus aureus in HIV-Infected Individuals in Comparison to HIV-Uninfected Individuals: A Case-Control Study. J Int Assoc Provid AIDS Care 2014; 15:141-7. [PMID: 25331220 DOI: 10.1177/2325957414554005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The study was conducted to evaluate the prevalence of nasal colonization of Staphylococcus aureus in individuals with HIV infection attending the Integrated Counselling and Testing Centre in a teaching hospital and compare the prevalence with HIV-uninfected individuals. A case-control study was conducted among newly diagnosed HIV-infected individuals and an equal number of age-group and sex-matched HIV-uninfected individuals, and nasal swabs were collected from both the samples. Sociodemographic and clinical data were collected through individual interviews. Ethical aspects were respected. A total of 100 individuals participated in the study, and 22 (44%) of the 50 HIV-infected cases were colonized by S aureus, including 19 (86.4%) methicillin-sensitive S aureus (MSSA) and 3 (13.6%) methicillin-resistant S aureus (MRSA). Only 12 (24%) strains were isolated from 50 HIV-uninfected individuals, with 11 being MSSA and 1 being MRSA. This difference in the isolation rate was statistically significant (P = .035). The 2 most commonly encountered risk factors in both the groups appeared to be history of tuberculosis and history of surgical procedures but none being statistically significant (P = .093 and P = .996). All the strains of S aureus were sensitive to mupirocin. The study concluded that HIV-infected individuals are at a higher risk of carriage as compared to HIV-uninfected individuals. By eliminating carriage in immunocompromised individuals, infections due to S aureus can also be minimized.
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Affiliation(s)
- Ruchi Kotpal
- Department of Microbiology, Microbiology at Super Religare Laboratories, Meerut, Uttar Pradesh, India
| | - Krishna Prakash S
- Department of Microbiology, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Preena Bhalla
- Department of Microbiology, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Richa Dewan
- Department of Medicine, Associated Lok Nayak Hospital, New Delhi, Delhi, India
| | - Ravinder Kaur
- Department of Microbiology, Maulana Azad Medical College, New Delhi, Delhi, India
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Kyaw W, Lee L, Siong W, Ping AC, Ang B, Leo Y. Prevalence of and risk factors for MRSA colonization in HIV-positive outpatients in Singapore. AIDS Res Ther 2012; 9:33. [PMID: 23126233 PMCID: PMC3540004 DOI: 10.1186/1742-6405-9-33] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/31/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND Whilst there have been studies on the risks and outcomes of MRSA colonization and infections in HIV-positive patients, local data is limited on the risk factors for MRSA colonization among these patients. We undertook this study in a tertiary HIV care centre to document the risk factors for colonization and to determine the prevalence of MRSA colonization among HIV-positive outpatients in Singapore. METHODS This was a cross-sectional study in which factors associated with MRSA positivity among patients with HIV infection were evaluated. A set of standardized questionnaire and data collection forms were available to interview all recruited patients. Following the interview, trained nurses collected swabs from the anterior nares/axilla/groin (NAG), throat and peri-anal regions. Information on demographics, clinical history, laboratory results and hospitalization history were retrieved from medical records. RESULTS MRSA was detected in swab cultures from at least 1 site in 15 patients (5.1%). Inclusion of throat and/or peri-anal swabs increased the sensitivity of NAG screening by 20%. Predictors for MRSA colonization among HIV-positive patients were age, history of pneumonia, lymphoma, presence of a percutaneous device within the past 12 months, history of household members hospitalized more than two times within the past 12 months, and a most recent CD4 count less than 200. CONCLUSIONS This study highlights that a proportion of MRSA carriers would have been undetected without multiple-site screening cultures. This study could shed insight into identifying patients at risk of MRSA colonization upon hospital visit and this may suggest that a risk factor-based approach for MRSA surveillance focusing on high risk populations could be considered.
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Shadyab AH, Crum-Cianflone NF. Methicillin-resistant Staphylococcus aureus (MRSA) infections among HIV-infected persons in the era of highly active antiretroviral therapy: a review of the literature. HIV Med 2012; 13:319-32. [DOI: 10.1111/j.1468-1293.2011.00978.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2011] [Indexed: 11/27/2022]
Affiliation(s)
- AH Shadyab
- Graduate School of Public Health; San Diego State University; San Diego; CA; USA
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18
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Crum-Cianflone NF, Shadyab AH, Weintrob A, Hospenthal DR, Lalani T, Collins G, Mask A, Mende K, Brodine SK, Agan BK. Association of methicillin-resistant Staphylococcus aureus (MRSA) colonization with high-risk sexual behaviors in persons infected with human immunodeficiency virus (HIV). Medicine (Baltimore) 2011; 90:379-389. [PMID: 22033452 DOI: 10.1097/md.0b013e318238dc2c] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infections are an important cause of morbidity, especially among human immunodeficiency virus (HIV)-infected persons. Since an increasing number of MRSA skin and soft tissue infections involve the perigenital areas, some have suggested that these infections may be sexually transmitted. We performed a cross-sectional study among HIV-infected adults from 4 geographically diverse United States military HIV clinics to determine the prevalence of and the factors (including sexual practices) associated with MRSA colonization. Swabs were collected from the nares, throat, axillae, groin area, and perirectal area for S. aureus colonization. Data on sociodemographic characteristics, medical conditions, and sexual history were collected. Multivariate logistic regression models evaluated factors associated with carriage. We studied 550 HIV-infected adults with a median age of 42 years; 93% were male; and race/ethnicity was white for 46%, African American for 35%, and other for 19%. Median CD4 count was 529 cells/mm, 11% had a history of a MRSA infection, and 21% had a sexually transmitted infection within the last year, including 8% with syphilis. One hundred eighty (33%) were colonized with S. aureus and 22 (4%) with MRSA. The most common location for carriage was the nares, followed by the perigenital area (groin or perirectal area). Factors associated with MRSA carriage in the multivariate analyses included a sexually transmitted infection in the last year (odds ratio [OR], 4.2; p<0.01), history of MRSA infection (OR, 9.4; p<0.01), and African American compared with white race/ethnicity (OR, 3.5; p=0.01). In separate multivariate models, syphilis, nongonococcal urethritis, and public bath use were also associated with MRSA carriage (all p<0.01). In conclusion, a history of recent sexually transmitted infections, including syphilis and urethritis, was associated with MRSA carriage. These data suggest that high-risk sexual activities may play a role in MRSA transmission.
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Affiliation(s)
- Nancy F Crum-Cianflone
- From Infectious Disease Clinical Research Program (NFCC, AW, DRH, TL, GC, AM, KM, BKA), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Infectious Disease Clinic (NFCC, AM), Naval Medical Center San Diego, San Diego, California; San Diego State University (NFCC, AHS, SKB), San Diego, California; Infectious Disease Clinic (AW), Walter Reed Army Medical Center, Washington, DC; Infectious Disease Service (DRH, KM), San Antonio Military Medical Center, San Antonio, Texas; Infectious Disease Clinic (TL), Naval Medical Center Portsmouth, Virginia; and Division of Biostatistics (GC), University of Minnesota, Minneapolis, Minnesota
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Sibanda EL, Weller IVD, Hakim JG, Cowan FM. Does trimethoprim-sulfamethoxazole prophylaxis for HIV induce bacterial resistance to other antibiotic classes? Results of a systematic review. Clin Infect Dis 2011; 52:1184-94. [PMID: 21467024 PMCID: PMC3070868 DOI: 10.1093/cid/cir067] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis has long been recommended for immunosuppressed HIV-infected adults and children born to HIV-infected women. Despite this, many resource-limited countries have not implemented this recommendation, partly because of fear of widespread antimicrobial resistance not only to TMP-SMX, but also to other antibiotics. We aimed to determine whether TMP-SMX prophylaxis in HIV-infected and/or exposed individuals increases bacterial resistance to antibiotics other than TMP-SMX. METHODS A literature search was conducted in Medline, Global Health, Embase, Web of Science, ELDIS, and ID21. RESULTS A total of 501 studies were identified, and 17 met the inclusion criteria. Only 8 studies were of high quality, of which only 2 had been specifically designed to answer this question. Studies were classified as (1) studies in which all participants were infected and/or colonized and in which rates of bacterial resistance were compared between those taking or not taking TMP-SMX and (2) studies comparing those who had a resistant infection with those who were not infected. Type 1 studies showed weak evidence that TMP-SMX protects against resistance. Type 2 studies provided more convincing evidence that TMP-SMX protects against infection. CONCLUSION There was some evidence that TMP-SMX prophylaxis protects against resistance to other antibiotics. However, more carefully designed studies are needed to answer the question conclusively.
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Affiliation(s)
- Euphemia L Sibanda
- Zimbabwe AIDS Prevention Project, Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Zimbabwe
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20
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Gordon RJ, Chez N, Jia H, Zeller B, Sobieszczyk M, Brennan C, Hisert KB, Lee MH, Vavagiakis P, Lowy FD. The NOSE study (nasal ointment for Staphylococcus aureus eradication): a randomized controlled trial of monthly mupirocin in HIV-infected individuals. J Acquir Immune Defic Syndr 2010; 55:466-72. [PMID: 20686410 PMCID: PMC2974816 DOI: 10.1097/qai.0b013e3181ec2a68] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV-positive patients at HELP/PSI, Inc, an in-patient drug rehabilitation center, had a high baseline prevalence of Staphylococcus aureus colonization (49%) and incidence of infection (17%) in a previous year-long study. METHODS A randomized, double-blinded, placebo-controlled study was conducted to determine whether repeated nasal application of mupirocin ointment would decrease the odds of S. aureus nasal colonization in 100 HELP/PSI patients over an 8-month period. A 5-day course of study drug was given monthly, and colonization was assessed at baseline and 1 month after each treatment. S. aureus infection was a secondary outcome. RESULTS In repeated-measures analysis, mupirocin reduced the odds of monthly S. aureus nasal colonization by 83% compared with placebo [adjusted odds ratio (ORadj) = 0.17; P < 0.0001]. Subjects colonized at study entry had a 91% reduction in subsequent colonization (ORadj = 0.09; P < 0.0001). Mupirocin also suppressed S. aureus colonization in subjects not colonized at baseline (ORadj = 0.23; P = 0.006). There was no difference in infection rates between the mupirocin and placebo groups (hazard ratio = 0.49, P = 0.29). CONCLUSIONS Monthly application of nasal mupirocin significantly decreased S. aureus colonization in HIV patients in residential drug rehabilitation. Monthly mupirocin application has a potential role in long-term care settings or in HIV-positive patients with high rates of S. aureus colonization and infection.
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Affiliation(s)
- Rachel J Gordon
- Department of Medicine, Columbia University, New York, NY, USA.
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Hidron AI, Kempker R, Moanna A, Rimland D. Methicillin-resistant Staphylococcus aureus in HIV-infected patients. Infect Drug Resist 2010; 3:73-86. [PMID: 21694896 PMCID: PMC3108732 DOI: 10.2147/idr.s7641] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Indexed: 01/09/2023] Open
Abstract
Concordant with the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the community setting, colonization and infections with this pathogen have become a prevalent problem among the human immunodeficiency virus (HIV)-positive population. A variety of different host- and, possibly, pathogen-related factors may play a role in explaining the increased prevalence and incidence observed. In this article, we review pathophysiology, epidemiology, clinical manifestations, and treatment of MRSA in the HIV-infected population.
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22
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Ramsetty SK, Stuart LL, Blake RT, Parsons CH, Salgado CD. Risks for methicillin-resistant Staphylococcus aureus colonization or infection among patients with HIV infection. HIV Med 2010; 11:389-94. [PMID: 20059572 DOI: 10.1111/j.1468-1293.2009.00802.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Risks for methicillin-resistant Staphylococcus aureus (MRSA) among those with HIV infection have been found to vary, and the epidemiology of USA-300 community-acquired (CA) MRSA has not been adequately described. METHODS We conducted a retrospective review of HIV-infected out-patients from January 2002 to December 2007 and employed multivariate logistic regression (MLR) to identify risks for MRSA colonization or infection. Pulsed-field gel electrophoresis (PFGE) was used to identify USA-300 strains. RESULTS Seventy-two (8%) of 900 HIV-infected patients were colonized or infected with MRSA. MLR identified antibiotic exposure within the past year [odds ratio (OR) 3.4; 95% confidence interval (CI) 1.5-7.7] and nadir CD4 count <200 cells/microL (OR 2.5; 95% CI 1.2-5.3) as risks for MRSA colonization or infection. Receipt of antiretroviral therapy (ART) within the past year was associated with decreased risk (OR 0.16; 95% CI 0.07-0.4). Eighty-nine percent of available strains were USA-300. MLR identified skin or soft tissue infection (SSTI) as the only predictor for infection with USA-300 (OR 5.9; 95% CI 1.4-24.3). CONCLUSION Significant risks for MRSA among HIV-infected patients were CD4 count nadir <200 cells/microL and antibiotic exposure. Only the presence of an SSTI was associated with having USA-300, and thus the use of patient characteristics to predict those with USA-300 was limited. In addition, ART within the previous year significantly reduced the risk of MRSA colonization or infection.
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Affiliation(s)
- S K Ramsetty
- Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC 29425, USA.
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Chacko J, Kuruvila M, Bhat GK. Factors affecting the nasal carriage of methicillin-resistant Staphylococcus aureus in human immunodeficiency virus-infected patients. Indian J Med Microbiol 2009; 27:146-8. [PMID: 19384039 DOI: 10.4103/0255-0857.49429] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Human immunodeficiency virus-infected patients attending skin outpatient department were studied for nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) and associated factors affecting nasal colonization. Nasal swabs were used for isolation of S. aureus. MRSA were detected by agar screen and agar dilution methods. Careful examination for dermatoses was carried out. Forty-six of the 60 (76.67%) outpatients with HIV infection were colonized with S. aureus in the anterior nares. Significant number of S. aureus carriers were in the 31-40 year age group. Methicillin resistance was found in eight (17.39%) isolates. Of the 46 S. aureus strains, 29 (63%) were resistant to erythromycin, 69.5% to co-trimoxazole and 41.3% to ciprofloxacin. Co-trimoxazole use was found to be a risk factor for S. aureus carriage ( P = 0.0214) but not for methicillin resistance. Hospital stay for more than 10 days was a risk factor for methicillin resistance whereas stay for more than 25 days was found to be a highly significant risk factor. Dermatophytosis and herpes simplex virus infection were other risk factors for nasal carriage of S. aureus.
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Affiliation(s)
- J Chacko
- Department of Microbiology, Kasturba Medical College, Mangalore, India
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Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in HIV-infected ambulatory patients. J Acquir Immune Defic Syndr 2008; 48:567-71. [PMID: 18645516 DOI: 10.1097/qai.0b013e31817e9b79] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Estimates of the prevalence of colonization with methicillin-resistant Staphylococcus aureus (MRSA) vary in HIV-infected patients. METHODS HIV clinic patients were prospectively cultured. Bilateral nasal and axillary swabs were plated on BBL CHROMagar MRSA media. Molecular typing was done by pulse-field gel electrophoresis, and staphylococcal cassette chromosomemec typing was determined. A patient questionnaire was conducted to ascertain potential MRSA risk factors; medical records were reviewed. RESULTS Fifteen of 146 (10.3%) patients had MRSA nasal colonization; 1 also had axillary colonization. Twelve of 15 isolates were staphylococcal cassette chromosomemec type IV, and 8 of 14 were USA300 or USA400 genotype. MRSA colonization was associated with lower CD4 cell count, not receiving current or recent antibiotics, history of prior MRSA or methicillin-susceptible Staphylococcus aureus infection (P < 0.05 for all), and a trend toward history of hospitalization or emergency department visit in the past year (P = 0.064). Current use of trimethoprim-sulfamethoxazole was protective for colonization: 0 of 29 trimethoprim-sulfamethoxazole recipients were colonized versus 15 of 117 nonrecipients, P = 0.04. In a multivariate logistic regression model, prior infection with either methicillin-susceptible S. aureus (odds ratio = 32.4, 95% confidence interval 3.04 to 345.42) or MRSA (odds ratio = 9.71, 95% confidence interval 2.20 to 43.01), not receiving current or recent antibiotics (odds ratio = 0.026, 95% confidence interval 0.002 to 0.412), and lower CD4 count (odds ratio 0.996, 95% confidence interval 0.992 to 0.999) were associated with MRSA colonization. DISCUSSION The prevalence of MRSA nasal colonization was relatively high compared with prior studies; axillary colonization was rare. Prior staphylococcal infection (methicillin-susceptible S. aureus or MRSA), not receiving antibiotics, and lower CD4 count were associated with MRSA nasal colonization. Trimethoprim-sulfamethoxazole seemed to be protective of MRSA colonization.
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Padoveze MC, de Jesus Pedro R, Blum-Menezes D, Bratfich OJ, Moretti ML. Staphylococcus aureus nasal colonization in HIV outpatients: persistent or transient? Am J Infect Control 2008; 36:187-91. [PMID: 18371514 DOI: 10.1016/j.ajic.2007.05.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 05/28/2007] [Accepted: 05/31/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Staphylococcus aureus nasal carriage in HIV patients remains incompletely characterized. The aim of the present study was to describe epidemiologic and molecular features of S. aureus nasal colonization in HIV outpatients. METHODS HIV outpatients with no history of hospitalization within the previous 2 years were screened for S aureus nasal colonization. Three samples were collected from each patient, and the risk factors for colonization were assessed. Nasal carriage was classified as persistent colonization, transient colonization, or no colonization. Persistent colonization was subdivided into simple (same DNA profile) or multiple (different DNA profiles) using pulsed-field gel electrophoresis (PFGE) for genotyping the strains of S. aureus. RESULTS A total of 111 patients were evaluated, of which 70 (63.1%) had at least 1 positive culture for S aureus. Patients in clinical stages of AIDS were more likely to be colonized than non-AIDS patients (P = .02). Among the patients with S aureus nasal carriage, 25.2% were transient carriers and 39.4% were persistent carriers. PFGE analysis showed that the persistent colonization was simple in 24 patients and multiple in 17 patients. CONCLUSION The HIV patients had a high rate of S. aureus nasal colonization. The most common characteristic of colonization was simple persistent colonization showing the same genomic profile.
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Affiliation(s)
- Maria Clara Padoveze
- Infectious Diseases Division, Faculty of Medical Science, State University of Campinas, Campinas, São Paulo, Brazil.
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Role of previous hospitalization in clinically-significant MRSA infection among HIV-infected inpatients: results of a case-control study. BMC Infect Dis 2007; 7:36. [PMID: 17470274 PMCID: PMC1868735 DOI: 10.1186/1471-2334-7-36] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Accepted: 04/30/2007] [Indexed: 11/10/2022] Open
Abstract
Background HIV-infected subjects have high incidence rates of Staphylococcus aureus infections, with both methicillin-susceptible and methicillin-resistant (MRSA) strains. Possible explanations could include the high burden of colonization, the behavioral risk factors, and the frequent exposures to health care facilities of HIV-infected patients. The purpose of the study was to assess the risk factors for clinically- significant methicillin-resistant Staphylococcus aureus (CS-MRSA) infections in HIV-infected patients admitted to Infectious Diseases Units. Methods From January 1, 2002 to December 31, 2005, we conducted a retrospective case-control (1:2) study. We identified all the cases of CS-MRSA infections in HIV-infected patients admitted to the National Institute for Infectious Diseases (INMI) "Lazzaro Spallanzani" in the 4-year study period. A conditional logistic regression model was used to identify risk factors for CS-MRSA infection. Results We found 27 CS-MRSA infections, i.e. 0.9 CS-MRSA infections per 100 HIV-infected individuals cared for in our Institute. At multivariate analysis, independent predictors of CS-MRSA infection were cumulative hospital stay, invasive procedures in the previous year, and low CD4 cell count. Particularly, the risk for CS-MRSA increased by 14% per an increase of 5 days hospitalization in the previous year. Finally, we identified a low frequency of community-acquired MRSA infections (only 1 of 27; 3.7%) among HIV-infected patients. Conclusion Clinicians should be aware of the risk for CS-MRSA infection in the clinical management of HIV-infected patients, especially in those patients with a low CD4 cell count, longer previous hospital stay, and previous invasive procedures.
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Skiest D, Brown K, Hester J, Moore T, Crosby C, Mussa HR, Hoffman-Roberts H, Cooper T. Community-onset methicillin-resistant Staphylococcus aureus in an urban HIV clinic. HIV Med 2006; 7:361-8. [PMID: 16903980 DOI: 10.1111/j.1468-1293.2006.00394.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the proportion of skin/soft tissue infections (SSTIs) and to determine risks for MRSA infection caused by methicillin-resistant Staphylococcus aureus (MRSA) in HIV-infected out-patients. METHODS We conducted a prospective study of SSTIs in HIV-infected out-patients. A questionnaire was used to record MRSA risk factors and treatment. In vitro testing for antibiotic susceptibility, inducible clindamycin resistance, panton-valentine leucocidin (PVL) toxin, and the staphylococcal chromosomal cassette mec (SCCmec) type was performed using standardized methods. Treatment outcomes included resolution of primary site of infection, nonresolution of infection and reinfection and were confirmed at clinic visit and/or telephone follow-up. RESULTS Forty-one of 44 patients had an SSTI caused by MRSA. African-Americans comprised 21 of 41 MRSA patients. The median CD4 count of MRSA patients was 411 cells/microL. Four patients required hospitalization and three patients had secondary bacteraemia. Twenty-one of 41 MRSA patients had healthcare-associated (HCA) MRSA risk factors including a history of prior MRSA infection (n=9) and hospitalization within 6 months (n=11). Other prevalent MRSA risk factors included receipt of systemic antibiotics within 6 months (n=21) and previous incarceration (n=19). Twenty-two patients had a significant non-HIV-related comorbid illness. The majority of isolates were susceptible to trimethoprim-sulfamethoxazole, tetracycline, and clindamycin. Inducible clindamycin resistance was detected in 0 of 16 erythromycin-resistant, clindamycin-susceptible MRSA isolates. Twenty-one of 24 isolates tested positive for SCCmec type IV. Twenty-four of 24 isolates tested positive for the PVL gene. Antibiotic treatment was discordant (bacteria nonsusceptible to antibiotic used) in eight MRSA patients. The primary SSTI resolved in 37 of 40 MRSA patients. Recurrence of infection at a site other than the primary site was relatively common (11 patients). CONCLUSIONS We found a high rate of MRSA causing SSTI in community-dwelling patients. The majority of isolates were positive for PVL and SCCmec IV, which is typical of community-associated MRSA isolates causing SSTIs in the general population. Inducible clindamycin resistance was not detected. Most patients had MRSA risk factors. The initial site of infection resolved in most cases but subsequent MRSA infection was relatively common.
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Affiliation(s)
- D Skiest
- Division of Infectious Diseases, The University of Texas Southwestern Medical Center, Dallas, USA.
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Achenbach C, Flores E, Ferrell P, Pitrak D, Weber SG. Prevalence of and risk factors for colonization with vancomycin-resistant enterococcus among human immunodeficiency virus-positive outpatients. Infect Control Hosp Epidemiol 2006; 27:102-4. [PMID: 16528868 DOI: 10.1086/499391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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