Major articlePrevalence and risk factors for methicillin-resistant Staphylococcus aureus in an HIV-positive cohort

- Risks for methicillin-resistant Staphylococcus aureus colonization were modeled for a clinical cohort of persons living with HIV.
- Forty percent were nares negative but were colonized at another anatomic site.
- Lower odds for colonization were associated with recent sexual activity and use of antiretroviral therapy.
- Increased odds were associated with lower income, recent hospitalization, incarceration, use of street drugs, and skin abscess.
- Screening for methicillin-resistant Staphylococcus aureus at multiple anatomic sites is indicated for persons living with HIV.

BackgroundPersons living with HIV (PLWH) are disproportionately burdened with methicillin-resistant Staphylococcus aureus (MRSA). Our objective was to evaluate prevalence and risks for MRSA colonization in PLWH.MethodsAdults were recruited from Johns Hopkins University AIDS Service in Baltimore, Maryland. A risk questionnaire and specimen collection from anatomic sites with culture susceptibility and genotyping were completed. Generalized estimating equation modeling identified MRSA colonization risk factors.ResultsOf 500 participants, most were black (69%), on antiretroviral therapy (ART) (87%), with undetectable viral loads (73.4%). Median CD4 count was 487 cells/mm3 (interquartile range, 316-676.5 cells/mm3). MRSA prevalence was 15.4%, predominantly from the nares (59.7%). Forty percent were nares negative but were colonized elsewhere. Lower odds for colonization were associated with recent sexual activity (adjusted odds ratio [AOR] = 0.84, P < .001) and ART (AOR = 0.85, P = .011). Increased odds were associated with lower income (<$25,000 vs >$75,000; AOR = 2.68, P < .001), recent hospitalization (AOR = 1.54, P < .001), incarceration (AOR = 1.55, P < .001), use of street drugs (AOR = 1.43, P < .001), and skin abscess (AOR = 1.19, P < .001).ConclusionsEven with high MRSA prevalence, the proportion identified through nares surveillance alone was low, indicating the importance of screening multiple anatomic sites. Associations were not found with same-sex coupling or black race. MRSA prevention might be a benefit of ART in PLWH.