Abstract
BackgroundSkin and soft tissue infections (SSTIs) are common in the era of community-associated methicillin resistant Staphylococcus aureus among HIV-infected patients. Recurrent infections are frequent. Risk factors for recurrence after an initial SSTI have not been well-studied.MethodsRetrospective cohort study, single center, 2005–2009. Paper and electronic medical records were reviewed by one of several physicians. Subjects with initial SSTI were followed until the time of SSTI recurrence. Standard descriptive statistics were calculated to describe the characteristics of subjects who did and did not develop a recurrent SSTI. Kaplan-Meier methods were used to estimate the risk of recurrent SSTI. A Cox regression model was developed to identify predictors of SSTI recurrence.Results133 SSTIs occurred in 87 individuals. 85 subjects were followed after their initial SSTI, of whom 30 (35.3 %) had a recurrent SSTI in 118.3 person-years of follow-up, for an incidence of second SSTI of 253.6 SSTIs/1000 person-years (95 % CI 166.8-385.7). The 1-year Kaplan-Meier estimated risk of a second SSTI was 29.2 % (95 % CI 20.3–41.0 %), while the 3-year risk was 47.0 % (95 % CI 34.4–61.6 %). Risk factors for recurrent SSTI in a multivariable Cox regression model were non-hepatitis liver disease (HR 3.44; 95 % CI 1.02–11.5; p = 0.05), the presence of an intravenous catheter (HR 6.50; 95 % CI 1.47–28.7; p = 0.01), and a history of intravenous drug use (IVDU) (HR 2.80; 95 % CI 1.02-7.65; p = 0.05); African-American race was associated with decreased risk of recurrent SSTI (HR 0.12; 95 % CI 0.04-0.41; p < 0.01). Some evidence was present for HIV viral load ≥ 1000 copies/mL as an independent risk factor for recurrent SSTI (HR 2.21; 95 % CI 0.99-4.94; p = 0.05). Hemodialysis, currently taking HAART, CD4+ count, trimethoprim-sulfamethoxazole or azithromycin use, initial SSTI type, diabetes mellitus, incision and drainage of the original SSTI, or self-report of being a man who has sex with men were not associated with recurrence.ConclusionOf HIV-infected patients with an SSTI, nearly 1/3 had a recurrent SSTI within 1 year. Risk factors for recurrent SSTI were non-hepatitis liver disease, intravenous catheter presence, a history of IVDU, and non-African-American race. Low CD4+ count was not a significant risk factor for recurrence.
Highlights
Skin and soft tissue infections (SSTIs) are common in the era of community-associated methicillin resistant Staphylococcus aureus among human immunodeficiency virus (HIV)-infected patients
Two subjects from the cohort had no followup time after the initial SSTI, so 85 subjects were included in the analysis reported in this study
We identified risk factors for recurrence which do not entirely overlap the risk factors for initial SSTI found in our previous paper [19] or in the work of others [20], though our studies differed from most other studies in examining all subjects with SSTIs, not just those with proven methicillin resistant Staphylococcus aureus (MRSA) SSTIs
Summary
Skin and soft tissue infections (SSTIs) are common in the era of community-associated methicillin resistant Staphylococcus aureus among HIV-infected patients. In 1998, the first increase in incidence of methicillin resistant Staphylococcus aureus (MRSA) infections in people without previous contact with the health care system was reported in children in Chicago [1]. A number of anecdotal reports have suggested that recurrent SSTIs are common among HIV-infected patients [7, 8], few studies have examined the incidence of and risk factors for recurrent SSTIs in the HIV-infected population in the current era of CA-MRSA [9,10,11,12]. We set out to examine the risk factors for SSTI recurrence in an HIVinfected population receiving care at an urban tertiary care center clinic in the CA-MRSA era
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