Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-30T21:40:49.208Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors for Colonization or Infection Due to Methicillin-Resistant Staphylococcus Aureus in HIV-Positive Patients A Retrospective Case-Control Study

Published online by Cambridge University Press:  02 January 2015

Michelle Onorato ,
Michael J. Borucki ,
Gwen Baillargeon ,
David P. Paar ,
Daniel H. Freeman ,
C. Pat Cole  and
C. Glen Mayhall
Michelle Onorato*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, and Office of Biostatistics, University of Texas Medical Branch, and the Department of Healthcare Epidemiology, University of Texas Medical Branch Hospitals and Clinics, Galveston, Texas
Michael J. Borucki
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, and Office of Biostatistics, University of Texas Medical Branch, and the Department of Healthcare Epidemiology, University of Texas Medical Branch Hospitals and Clinics, Galveston, Texas
Gwen Baillargeon
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, and Office of Biostatistics, University of Texas Medical Branch, and the Department of Healthcare Epidemiology, University of Texas Medical Branch Hospitals and Clinics, Galveston, Texas
David P. Paar
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, and Office of Biostatistics, University of Texas Medical Branch, and the Department of Healthcare Epidemiology, University of Texas Medical Branch Hospitals and Clinics, Galveston, Texas
Daniel H. Freeman
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, and Office of Biostatistics, University of Texas Medical Branch, and the Department of Healthcare Epidemiology, University of Texas Medical Branch Hospitals and Clinics, Galveston, Texas
C. Pat Cole
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, and Office of Biostatistics, University of Texas Medical Branch, and the Department of Healthcare Epidemiology, University of Texas Medical Branch Hospitals and Clinics, Galveston, Texas
C. Glen Mayhall
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, and Office of Biostatistics, University of Texas Medical Branch, and the Department of Healthcare Epidemiology, University of Texas Medical Branch Hospitals and Clinics, Galveston, Texas
*
Division of Infectious Diseases, University of Texas Medical Branch, 301 University Blvd, Galveston. TX 77555-0835
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the risk factors for colonization or infection with methicillin-resistant Staphylococcus aureus in human immunodeficiency virus (HIV)-infected patients.

Design:

Retrospective matched-pair case-control study.

Setting:

Continuity clinic and inpatient HIV service of a university medical center.

Population:

Patients with HIV infection from the general population of eastern and coastal Texas and from the Texas Department of Criminal Justice.

Data Collection:

Patient charts and the AIDS Care and Clinical Research Program Database were reviewed for the following: age, race, number of admissions, total hospital days, presence of a central venous catheter, serum albumin, total white blood cell count and absolute neutrophil count, invasive or surgical procedures, any cultures positive for S aureus, and a history of opportunistic illnesses, diabetes, or dermatologie diagnoses. Data also were collected on the administration of antibiotics, antiretroviral therapy, steroids, cancer chemotherapy, and subcutaneous medications.

Results:

In the univariate analysis, the presence of a central venous catheter, an underlying dermatologie disease, lower serum albumin, prior steroid therapy, and prior antibiotic therapy, particularly antistaphylococcal therapy or multiple courses of antibiotics, were associated with increased risk for colonization or infection with methicillin-resistant S aureus. Multivariate analysis yielded a model that included presence of a central venous catheter, underlying dermatologie disease, broad-spectrum antibiotic exposure, and number of hospital days as independent risk factors for colonization or infection with methicillin-resistant S aureus.

Conclusions:

In our HIV-infected patient population, prior hospitalization, exposure to broad-spectrum antibiotics, presence of a central venous catheter, and dermatologie disease were risk factors for acquisition of methicillin-resistant S aureus

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 1 , January 1999 , pp. 26 - 30
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Krumholz, HM, Sande, MA, Lo, B. Community-acquired bacteremia in patients with acquired immunodeficiency syndrome: clinical presentation, bacteriology and outcome. Am J Med 1989;86:776–779.CrossRefGoogle ScholarPubMed
2. Raviglione, MC, Battan, R, Pablos-Mendez, A, Aceves-Casillas, P, Mullen, MP, Taranta, A. Infections associated with Hickman catheters in patients with the acquired immunodeficiency syndrome. Am J Med 1989;86:780–786.CrossRefGoogle ScholarPubMed
3. Skoutelis, AT, Murphy, RL, MacDonell, KB, VonRoenn, JH, Sterkel, CD, Phair, JP. Indwelling central venous catheter infections in patients with acquired immune deficiency syndrome. J Acquir Immune Defic Syndr Hum Retroviral 1990;3:335–342.Google ScholarPubMed
4. Stroud, L, Srivastava, P, Culver, D, Bisno, A, Rimland, D, Simberkoff, M, et al. Nosocomial infections in HIV-infected patients: preliminary results from a multicenter surveillance system (1989-1995). Infect Control Hosp Epidemiol 1997;18:479–485.CrossRefGoogle ScholarPubMed
5. Knapp, CC, Ludwig, MD, Washington, JA. Evaluation of differential inoculum disk diffusion method and Vitek GPS-SA card for detection of oxacillin-resistant staphylococci. J Clin Microbiol 1994;32:433–436.CrossRefGoogle ScholarPubMed
6. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
7. Crossley, K, Loesch, D, Landesman, B, Mead, K, Chern, M, Strate, R. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides, I: clinical studies. J Infect Dis 1979;139:273–279.CrossRefGoogle ScholarPubMed
8. Peacock, JE Jr, Marsik, FJ, Wenzel, RP. Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med 1980;93:526–532.CrossRefGoogle ScholarPubMed
9. Ward, TT, Winn, RE, Hartstein, AI, Sewell, DL. Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: role of antimicrobial therapy in infection control. Infect Control 1981;2:453–459.CrossRefGoogle Scholar
10. Locksley, RM, Cohen, ML, Quinn, TC, Tompkins, LS, Coyle, MB, Kirihara, JM, et al. Multiply antibiotic-resistant Staphylococcus aureus: introduction, transmission, and evolution of nosocomial infection. Ann Intern Med 1982;97:317–324.CrossRefGoogle ScholarPubMed
11. Bitar, CM, Mayhall, CG, Lamb, VA, Bradshaw, TJ, Spadora, AC, Dalton, HP. Outbreak due to methicillin- and rifampin-resistant Staphylococcus aureus: epidemiology and eradication of the resistant strain from the hospital. Infect Control 1987;8:15–23.CrossRefGoogle ScholarPubMed
12. Rimland, D. Nosocomial infections with methicillin and tobramycin resistant Staphylococcus aureus—implication of physiotherapy in hospital-wide dissemination. Am J Med Sci 1985;290:91–97.CrossRefGoogle ScholarPubMed
13. Arnow, PM, Allyn, PA, Nichols, EM, Hill, DL, Pezzlo, M, Bartlett, RH. Control of methicillin-resistant Staphylococcus aureus in a burn unit: role of nurse staffing. J Trauma 1982;22:954–959.CrossRefGoogle Scholar
14. Lentino, JR, Hennein, H, Krause, S, Pappas, S, Fuller, G, Schaaf, D, et al. A comparison of pneumonia caused by gentamicin, methicillin-resistant and gentamicin, methicillin-sensitive Staphylococcus aureus: epidemiologic and clinical studies. Infect Control 1985;6:267–272.CrossRefGoogle ScholarPubMed
15. Pujol, M, Peña, C, Panares, R, Ayats, J, Ariza, J, Gudiol, F. Risk factors for nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus . Eur J Clin Microbiol Infect Dis 1994;13:96–102.CrossRefGoogle ScholarPubMed
16. Boyce, JM, Landry, M, Deetz, TR, DuPont, HL. Epidemiologic studies of an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections. Infect Control 1981;2:110–116.CrossRefGoogle ScholarPubMed
17. Leyden, JJ, Marples, RR, Kligman, AM. Staphylococcus aureus in the lesions of atopic dermatitis. Br J Dermatol 1974;90:525–530.CrossRefGoogle ScholarPubMed
18. Bibel, DJ, Greenberg, JH, Cook, JL. Staphylococcus aureus and the microbial ecology of atopic dermatitis. Can J Microbiol 1977;23:1062–1068.CrossRefGoogle ScholarPubMed
19. Hanifin, JM, Rogge, JL. Staphylococcal infections in patients with atopic dermatitis. Arch Dermatol 1977;113:1383–1386.CrossRefGoogle ScholarPubMed
20. Dahl MV. Staphylococcus aureus and atopic dermatitis. Arch Dermatol 1983;119:840–846.CrossRefGoogle Scholar
21. Aly, R, Maibach, HI, Mandel, A. Bacterial flora in psoriasis. Br J Dermatol 1976;95:603–606.CrossRefGoogle ScholarPubMed
22. Marples, RR, Heaton, CL, Kligman, AM. Staphylococcus aureus in psoriasis. Arch Dermatol 1973;107:568–570.CrossRefGoogle ScholarPubMed
23. Noble, WC, Savin, JA. Carriage of Staphylococcus aureus in psoriasis. BMJ 1968;1:417–418.CrossRefGoogle ScholarPubMed