Methicillin-ResistantStaphylococcus aureusColonization of the Groin and Risk for Clinical Infection among HIV-infected Adults

Philip J Peters,H Ken Lowery,Brandi Limbago,Linda K Mcdougal,John T Brooks,Rachel J Gorwitz,Sigrid K Mcallister,Jeffrey Hageman,Gregory Fosheim,Monique Bethea,Jodie L Guest,David Rimland,Rondeen Mindley

doi:10.3201/eid1904.121353

Abstract

Data on the interaction between methicillin-resistant Staphylococcus aureus (MRSA) colonization and clinical infection are limited. During 2007–2008, we enrolled HIV-infected adults in Atlanta, Georgia, USA, in a prospective cohort study. Nares and groin swab specimens were cultured for S. aureus at enrollment and after 6 and 12 months. MRSA colonization was detected in 13%–15% of HIV-infected participants (n = 600, 98% male) at baseline, 6 months, and 12 months. MRSA colonization was detected in the nares only (41%), groin only (21%), and at both sites (38%). Over a median of 2.1 years of follow-up, 29 MRSA clinical infections occurred in 25 participants. In multivariate analysis, MRSA clinical infection was significantly associated with MRSA colonization of the groin (adjusted risk ratio 4.8) and a history of MRSA infection (adjusted risk ratio 3.1). MRSA prevention strategies that can effectively prevent or eliminate groin colonization are likely necessary to reduce clinical infections in this population.

Highlights

Community-associated Methicillin-resistant Staphylococcus aureus (MRSA) (CA-MRSA) refers to an MRSA infection with onset in the community in an individual lacking established MRSA risk factors, such as recent hospitalization, surgery, residence in a long-term care facility, receipt of dialysis, or presence of invasive medical devices[5]
Community-associated MRSA (CA-MRSA) refers to an MRSA infection with onset in the community in an individual lacking established MRSA risk factors, such as recent hospitalization, surgery, residence in a long-term care facility, receipt of dialysis, or presence of invasive medical devices[5]. This term has been used to refer to MRSA strains with bacteriologic characteristics considered typical of isolates obtained from patients with CA-MRSA infections[6], an association initially observed between microbiologic characteristics and MRSA transmission in the community versus healthcare settings appears to be breaking down
From a clinical management standpoint, awareness of local resistance patterns for pathogens in the differential diagnosis of specific clinical syndromes is more important than formally categorizing possible MRSA infections as CA-MRSA or healthcare-associated MRSA (HA-MRSA); some assessment of healthcare exposure may be useful in predicting isolate resistance to particular antimicrobial agents

Summary

Introduction

Community-associated MRSA (CA-MRSA) refers to an MRSA infection with onset in the community in an individual lacking established MRSA risk factors, such as recent hospitalization, surgery, residence in a long-term care facility, receipt of dialysis, or presence of invasive medical devices[5]. In July 2004, the Centers for Disease Control and Prevention (CDC) convened a meeting of experts to describe reasonable strategies for the clinical and public health management of MRSA in the community.

Results

Conclusion