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

• Authors: Philip J. Peters, Emory University; John T. Brooks, Emory University; Sigrid K. McAllister, Centers for Disease Control and Prevention; Brandi Limbago, Centers for Disease Control and Prevention; H. Ken Lowery, Veteran Affairs Medical Center; Gregory Fosheim, Centers for Disease Control and Prevention; Jodie L. Guest, Emory University; Rachel J. Gorwitz, Centers for Disease Control and Prevention; Monique Bethea, Veteran Affairs Medical Center; Jeffrey Hageman, Centers for Disease Control and Prevention; Rondeen Mindley, Veteran Affairs Medical Center; Linda K. McDougal, Centers for Disease Control and Prevention; David Rimland, Emory University
• Journal Title: Emerging Infectious Disease
• Volume: Volume 19, Number 4
• Publisher: Centers for Disease Control and Prevention | 2013-04-01, Pages 623-629
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3201/eid1904.121353
• Subjects: Health Sciences, Immunology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; NASAL CARRIAGE; UNITED-STATES; SKIN INFECTIONS; PREVALENCE; EMERGENCE; POPULATION; CARE; MRSA; SEX; MEN

Abstract

Data on the interaction between methicillin-resistant Staphylococcus aureus (MRSA) colonization and clinical infection are limited. During 2007-2008, we enrolled HIVinfected adults in Atlanta, Georgia, USA, in a prospective cohort study. Nares and groin swab specimens were cultured for S. aureus at enrollment and after 6 and 12 months. MRSA colonization was detected in 13%-15% of HIV-infected participants (n = 600, 98% male) at baseline, 6 months, and 12 months. MRSA colonization was detected in the nares only (41%), groin only (21%), and at both sites (38%). Over a median of 2.1 years of follow-up, 29 MRSA clinical infections occurred in 25 participants. In multivariate analysis, MRSA clinical infection was significantly associated with MRSA colonization of the groin (adjusted risk ratio 4.8) and a history of MRSA infection (adjusted risk ratio 3.1). MRSA prevention strategies that can effectively prevent or eliminate groin colonization are likely necessary to reduce clinical infections in this population.