社区相关性耐甲氧西林金黄色葡萄球菌和 HIV：相交的传染病。
Community-associated methicillin-resistant Staphylococcus aureus and HIV: intersecting epidemics.
机构信息
Rush University Medical Center, Chicago, Illinois 60612, USA.
出版信息
Clin Infect Dis. 2010 Apr 1;50(7):979-87. doi: 10.1086/651076.
BACKGROUND
Single-site studies have suggested a link between human immunodeficiency virus (HIV) and community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA).
METHODS
Population-level incidence of HIV-infected patients with CA-MRSA versus community-associated methicillin-susceptible S. aureus (CA-MSSA) infection was assessed in the Cook County Health and Hospitals System (CCHHS), a multi-hospital and ambulatory care center. Rates in zip codes, including those with a high density of individuals with prior incarceration (ie, high-risk zip codes), were calculated. We did a nested case-control analysis of hospitalized HIV-infected patients with S. aureus skin and soft-tissue infections (SSTIs).
RESULTS
In CCHHS, the incidence of CA-MRSA SSTIs was 6-fold higher among HIV-infected patients than it was among HIV-negative patients (996 per 100,000 HIV-infected patients vs 157 per 100,000 other patients; P < .001). The incidence of CA-MRSA SSTIs among HIV-infected patients significantly increased from 2000-2003 (period 1) to 2004-2007 (period 2) (from 411 to 1474 cases per 100,000 HIV-infected patients; relative risk [RR], 3.6; P<.001), with cases in period 1 clustering in an area 6.3 km in diameter (P=.035) that overlapped high-risk zip codes. By period 2, CA-MRSA SSTIs among HIV-infected patients were spread throughout Cook County. USA300 was identified as the predominant strain by pulsed-field gel electrophoresis (accounting for 86% of isolates). Among hospitalized HIV-infected patients, the incidence of CA-MRSA increased significantly from period 1 to period 2 (from 190 to 779 cases per 100,000 HIV-infected patients; RR, 4.1; P<.001). Risks for CA-MRSA by multivariate analysis were residence in alternative housing (eg, shelters), residence in high-risk zip codes, younger age, and infection in period 2.
CONCLUSIONS
HIV-infected patients are at markedly increased risk for CA-MRSA infection. This risk may be amplified by overlapping community networks of high-risk patients that may be targets for prevention efforts.
背景
一些单中心研究提示人类免疫缺陷病毒（HIV）与社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）之间存在关联。
方法
在多医院和门诊护理中心库克县卫生与医院系统（CCHHS）中，评估了 HIV 感染患者中社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）与社区获得性甲氧西林敏感金黄色葡萄球菌（CA-MSSA）感染的人群水平发病率。计算了邮政编码（包括先前监禁人数较多的邮政编码，即高危邮政编码）的发病率。我们对住院 HIV 感染合并金黄色葡萄球菌皮肤和软组织感染（SSTI）的患者进行了嵌套病例对照分析。
结果
在 CCHHS，HIV 感染患者中 CA-MRSA SSTI 的发病率是 HIV 阴性患者的 6 倍（每 100000 例 HIV 感染患者中有 996 例 vs 每 100000 例其他患者中有 157 例；P<0.001）。HIV 感染患者中 CA-MRSA SSTI 的发病率从 2000-2003 年（第 1 期）显著增加到 2004-2007 年（第 2 期）（每 100000 例 HIV 感染患者中从 411 例增加到 1474 例；相对风险[RR]为 3.6；P<0.001），第 1 期病例聚集在一个直径 6.3 公里的区域（P=0.035），该区域与高危邮政编码重叠。到第 2 期，HIV 感染患者的 CA-MRSA SSTI 已遍布库克县。美国 300 型通过脉冲场凝胶电泳（占分离株的 86%）被鉴定为主要菌株。在住院 HIV 感染患者中，CA-MRSA 的发病率从第 1 期显著增加到第 2 期（每 100000 例 HIV 感染患者中从 190 例增加到 779 例；RR 为 4.1；P<0.001）。多变量分析的 CA-MRSA 危险因素包括居住在替代住房（如收容所）、居住在高危邮政编码、年龄较小以及第 2 期感染。
结论
HIV 感染患者发生 CA-MRSA 感染的风险显著增加。高危患者重叠的社区网络可能会放大这种风险，而这些社区网络可能是预防工作的目标。
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