Methicillin-resistant Staphylococcus aureus nasal colonization among HIV-infected patients in Taiwan: prevalence, molecular characteristics and associated factors with nasal carriage

Yi-Yu Hsu,Ting-Shu Wu,Chien-Chang Yang,Hsieh-Shong Leu,David Wu,Yhu-Chering Huang,Ching-Tai Huang,Fang-Hsueh Yuan,Shie-Shian Huang,Chien-Ching Hung,Ming-Hsun Lee,Po-Yen Huang,Shian-Sen Shie,Chun-Wen Cheng

doi:10.1186/s12879-020-04979-8

Abstract

BackgroundTo evaluate nasal carriage, antibiotic susceptibility and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA), as well as the risk factors of MRSA colonization, in human immunodeficiency virus (HIV)-infected patients in northern Taiwan.MethodsFrom September 2014 to November 2015, HIV-infected patients seeking outpatient care at four hospitals were eligible for this study. A nasal specimen was obtained from each subject for the detection of S. aureus and a questionnaire was completed by each subject. MRSA isolates once identified were characterized.ResultsOf 553 patients surveyed, methicillin-susceptible S. aureus (MSSA) was detected in 119 subjects (21.5%) and MRSA in 19 subjects (3.4%). Female gender, injection drug use, smoking, hepatitis C virus carrier, cancer and antibiotic use within 1 year were positively associated with MRSA colonization. By multivariate analysis, only cancer (adjust odds ratio (aOR) 7.78, [95% confidence interval (CI), 1.909–31.731]) and antibiotic use within 1 year (aOR 3.89, [95% CI, 1.219–12.433]) were significantly associated with MRSA colonization. Ten isolates were characterized as sequence type (ST) 59/staphylococcal chromosome cassette (SCC) IV or VT, endemic community strains in Taiwan, four isolates as ST 8/SCCmec IV (USA 300) and one isolate as ST 239/SCCmec IIIA, a hospital strain. All the community-associated MRSA isolates were susceptible to trimethoprim-sulfamethoxazole (TMP-SMX).ConclusionsNasal MRSA carriage in HIV-infected patients seeking outpatient care was low (3.4%) in northern Taiwan. Most of the colonizing isolates were genetically endemic community strains and exhibited high susceptibility to TMP-SMX and fluoroquinolones. Cancer and antibiotic use within 1 year were associated with MRSA colonization.

Highlights

To evaluate nasal carriage, antibiotic susceptibility and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA), as well as the risk factors of MRSA colonization, in human immunodeficiency virus (HIV)-infected patients in northern Taiwan
Cancer and antibiotic use within 1 year were associated with MRSA colonization
In the late 1990s, MRSA began to be recognized as a major cause of community-onset infections, which was termed as community-associated MRSA (CA-MRSA) later [2,3,4]

Summary

Introduction

Antibiotic susceptibility and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA), as well as the risk factors of MRSA colonization, in human immunodeficiency virus (HIV)-infected patients in northern Taiwan. Carriage of S. aureus, including MRSA, has been identified as a predisposing factor for subsequent invasive infections [5, 6], and the anterior nares are the most common site of colonization. Risk factors for S. aureus colonization appear to be different among different populations, including patients infected with HIV [11, 15,16,17]. MRSA colonization in HIV-infected patients may vary widely in different geographical regions [15, 18,19,20,21], the time point of survey [14], and the coverage of antiretroviral therapy in the population [22]

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Conclusion