Abstract
Background. Methicillin-resistant Staphylococcus aureus (MRSA) infection incidence has increased in healthy US children. Our objective was to evaluate MRSA incidence and correlates in HIV-infected youth. Methods. The CDC-sponsored LEGACY study is a US multicenter chart abstraction study of HIV-infected youth. We identified MRSA infections among participants with ≥1 visit during 2006. We used bivariate and multivariable analyses to compare sociodemographic and HIV clinical factors between MRSA cases and noncases. Results. Fourteen MRSA infections (1 invasive, 12 soft tissue, 1 indeterminate) occurred among 1,813 subjects (11.1 infections/1,000 patient-years (PY), 95% CI: 11.06–11.14). Most (86%) isolates were clindamycin susceptible. Compared with noncases, MRSA cases were more likely older (17 versus 14 years), black (100% versus 69%), behaviorally HIV infected (43% versus 17%), and in Maryland (43% versus 7%) and had viral loads (VL) >1000 copies/mL (86% versus 51%) and lower mean CD4% (18% versus 27%) (all P < 0.05). In multivariate analysis, independent risk factors were Maryland care site (adjusted odds ratio (aOR) = 9.0), VL >1000 copies/mL (aOR = 5.9), and black race (aOR undefined). Conclusions. MRSA occurred at a rate of 11.1 infections/1,000 PY in HIV-infected youth but invasive disease was uncommon. Geographic location, black race, and increased VL, but not immunosuppression, were independently associated with MRSA risk.
Highlights
Throughout the United States, Methicillin-resistant Staphylococcus aureus (MRSA) infections have increased dramatically in healthy adults and children without more commonly healthcare-associated MRSA (HA-MRSA) risk factors, such as recent hospitalization or surgery, indwelling catheter or residence in a long-term care facility [1,2,3,4,5]
The predominance of soft tissue infections (SSTIs), the low rate of bacteremia or other invasive infections, and the very low rate of clindamycin resistance are more typical of community-associated MRSA (CAMRSA) infections and suggest that most of these infections were caused by CA-MRSA rather than HA-MRSA strains [1, 5, 19]
MRSA infections in a cohort of HIV-infected children and adolescents occurred at a rate higher than that observed among healthy children in the general population, but invasive disease was uncommon
Summary
Throughout the United States, MRSA infections have increased dramatically in healthy adults and children without more commonly healthcare-associated MRSA (HA-MRSA) risk factors, such as recent hospitalization or surgery, indwelling catheter or residence in a long-term care facility [1,2,3,4,5]. Most circulating CA-MRSA strains cause skin and soft tissue infections (SSTIs), though invasive infections occur and may AIDS Research and Treatment be increasing [6,7,8,9]. These same CA-MRSA strains have increasingly caused infections in healthcare settings and in patients with traditional risk factors for HA-MRSA [10,11,12]. MRSA cases were more likely older (17 versus 14 years), black (100% versus 69%), behaviorally HIV infected (43% versus 17%), and in Maryland (43% versus 7%) and had viral loads (VL) >1000 copies/mL (86% versus 51%) and lower mean CD4% (18% versus 27%) (all P < 0.05). Geographic location, black race, and increased VL, but not immunosuppression, were independently associated with MRSA risk
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