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. Peters
, 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
, 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
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.
Page created: March 13, 2013
Page updated: March 13, 2013
Page reviewed: March 13, 2013
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.