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Volume 19, Number 4—April 2013

Research

Methicillin-Resistant Staphylococcus aureus Colonization of the Groin and Risk for Clinical Infection among HIV-infected Adults

Philip J. PetersComments to Author , John T. Brooks, Sigrid K. McAllister, Brandi Limbago, H. Ken Lowery, Gregory Fosheim, Jodie L. Guest, Rachel J. Gorwitz, Monique Bethea, Jeffrey Hageman, Rondeen Mindley, Linda K. McDougal, and David Rimland
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P.J. Peters, J.T. Brooks, S.K. McAllister, B. Limbago, G. Fosheim, R.J. Gorwitz, J. Hageman, L.K. McDougal); Veterans Affairs Medical Center, Atlanta (H.K. Lowery, J.L. Guest, M. Bethea, R. Mindley, D. Rimland); Emory University School of Medicine, Atlanta (D. Rimland)

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Table 3

Factors associated with MRSA clinical infection among 600 HIV-infected adults, Atlanta, Georgia, USA, 2007–2009*

Factor With MRSA clinical infection, n = 25 Without MRSA clinical infection, n = 575 Relative risk (95% CI)† Adjusted relative risk (95% CI)
Median age, y (IQR) 50 (45–58) 52 (45–60) p = 0.48
Sex
M 25 (4) 565 (96) 1.0
F 0 10 (100) NC
Race/ethnicity
Non-Hispanic Black 22 (5) 419 (95) 1.0
Non-Hispanic White 3 (2) 147 (98) 2.5 (0.8–8.2)
Hispanic, other, or not specified 0 9 (100) NC
HIV transmission risk
MSM 14 (4) 301 (96) 1.0
IDU 3 (4) 67 (96) 1.0 (0.3–3.3)
MSM and IDU 0 19 (100) NC†
High-risk heterosexual contact‡ 1 (3) 34 (97) 0.7 (0.1–4.7)
No risk factor specified or other§ 7 (4) 154 (96) 1.0 (0.4–2.5)
CD4 cell count, median cells/μL (IQR) 340 (85–482) 419 (253–582) p = 0.05
CD4 cell count, cells/μL (%)
  >500 5 (2) 213 (98) 1.0
  201–500 12 (4) 257 (96) 1.9 (0.7–5.4)
  ≤200 8 (7) 105 (93) 3.1 (1.0–9.2)
HIV viral load, copies/mL (%)
≥400 14 (7) 188 (93) 1.0
<400 10 (3) 374 (97) 0.4 (0.2–0.9)
MRSA baseline colonization
Not MRSA colonized 13 (2) 508 (98) 1.0 1.0
MRSA colonized in groin 12 (24) 37 (76) 9.8 (4.7–20.3) 4.8 (2.1–10.8)
MRSA colonized in nares only 0 30 (100) NC NC
Medical history
Abscess 11 (9) 117 (91) 2.9 (1.3–7.0)
Cellulitis 4 (10) 36 (90) 2.9 (0.9–8.8)
MRSA clinical infection 11 (14) 70 (86) 5.0 (2.4–10.7) 3.1 (1.4–7.3)
MSSA clinical infection 2 (4) 48 (96) 1.0 (0.2–3.9)
Hospitalization in past 12 mo 5 (6) 79 (94) 1.5 (0.6–4.0)
Diabetes 4 (6) 67 (12) 1.4 (0.5–4.0)
Renal insufficiency 5 (10) 47 (90) 2.6 (1.0–6.7) 2.9 (0.9–9.3)
Syphilis 10 (8) 109 (92) 2.7 (1.2–5.8)
Current medications
Antiretroviral therapy 16 (3) 458 (97) 0.5 (0.2–1.0)
Prescribed PCP§ prophylaxis 4 (4) 109 (96) 0.8 (0.3–2.4)
Prescribed TMP/SMX as PCP prophylaxis 2 (3) 78 (97) 0.6 (0.1–2.4)
Antibiotic use in past 1 y
Any with anti–S. aureus activity¶ 11 (4) 260 (96) 1.0 (0.4–2.1)
Any fluoroquinolone 3 (4) 77 (96) 0.9 (0.3–2.9)
TMP/SMX, not as PCP prophylaxis 7 (8) 78 (92) 2.4 (1.0–5.5)
Azithromycin 5 (5) 88 (95) 1.3 (0.5–3.5)
Vancomycin or linezolid 3 (14) 19 (86) 3.6 (1.2–11.1)
Resided in past 12 mo
Prison or jail 5 (12) 37 (88) 3.3 (1.3–8.4) 2.5 (0.97–6.7)
Homeless shelter 2 (5) 42 (95) 1.1 (0.3–4.5)
Sexual behavior in past 12 mo
Sexually active 16 (4) 368 (96) 1.0 (0.4–2.2)
Sex with male same-sex partner 11 (4) 234 (96) 1.1 (0.5–2.4)
Sex with ≥2 male same-sex partners 7 (5) 130 (95) 1.3 (0.5–3.0)
Condom usage in past 12 mo
  Not sexually active 9 (4) 200 (96) 1.0
  Frequent or sometimes 14 (4) 318 (96) 1.0 (0.4–2.2)
  Rare or never 2 (3) 57 (97) 1.3 (0.3–5.7)
Hygienic factors in past 12 mo
Have skin contact with abscess 10 (7) 124 (93) 2.3 (1.1–5.0)
Get bug bites 10 (4) 229 (96) 1.0 (0.5–2.2)
Bite fingernails 5 (4) 134 (96) 0.8 (0.3–2.2)
Pick nose 14 (6) 240 (94) 1.7 (0.8–3.8)
Pick skin 7 (5) 123 (95) 1.4 (0.6–3.3)
Use public hot tub or sauna 5 (7) 67 (93) 1.8 (0.7–4.7)
Shave face 20 (4) 424 (96) 1.4 (0.5–3.7)
Shave head 12 (8) 141 (92) 2.7 (1.3–6.4) 2.1 (0.9–4.7)
Shave chest 5 (10) 46 (90) 2.7 (1.1–6.9)
Shave groin, genital, or buttock area 10 (9) 104 (91) 2.8 (1.3–6.2) 2.1 (0.9–6.7)
Drug use in past 12 mo
Methamphetamine 0 20 (100) NC
Cocaine or crack 3 (3) 89 (97) 0.8 (0.2–2.5)
Poppers or nitrites 3 (5) 53 (95) 1.3 (0.4–4.3)
Injected or skin-popped any drug 0 13 (100) NC

*Values are no. (%) unless otherwise indicated. Boldface indicates significant results. MRSA, methicillin-resistant Staphylococcus aureus; IQR, interquartile range; NC, not calculated because there were insufficient events to calculate the relative risk; MSM, men who have sex with men; IDU, injection drug use; MSSA, methicillin-susceptible S. aureus; PCP, Pneumocystis pneumonia; TMP/SMX, trimethoprim/sulfamethoxazole.
†p values are Wilcoxon rank-sum test results.
‡Sexual contact with a person known to be HIV-infected or at high risk for HIV infection (e.g., history of IDU or MSM).
§Risk not specified or unknown (n = 152); other (n = 9) indicates transfusion (n = 4) or health care worker occupational exposure (n = 5).
¶Antibiotics with anti-staphylococcal activity used were fluoroquinolones, TMP/SMX, azithromycin, clarithromycin, mupirocin, cephalexin, vancomycin, linezolid, and ampicillin-clavulanate.

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