Sullivan Sean B, Kamath Suneel, McConville Thomas H, Gray Brett T, Lowy Franklin D, Gordon Peter G, Uhlemann Anne-Catrin
Departments of Medicine and.
Departments ofMedicine and; Northwestern Memorial Hospital, Chicago, Illinois.
Open Forum Infect Dis. 2016 Dec 20;3(4):ofw234. doi: 10.1093/ofid/ofw234. eCollection 2016 Oct.
People living with human immunodeficiency virus (PLWH) have been disproportionally affected by methicillin-resistant (MRSA) colonization and infection, in particular by clones USA300 and USA500. However, the contribution of epidemiological, bacterial, and immunological risk factors to the excess of in PLWH remain incompletely understood.
In this cross-sectional study, we determined the prevalence and molecular epidemiology of colonization in 93 PLWH attending an urban human immunodeficiency virus (HIV) clinic. Participants completed a structured interview assessing demographic information and risk factors for MRSA. Swabs were obtained from the nose, throat, and groin and cultured for and .
Most participants had well controlled HIV infection (89, 96% CD4 >200). Thirty-six (39%) individuals were colonized with at 1 or more body sites, including 6 (6%) with MRSA. Regular gym use was a risk factor for but not MRSA carriage. In contrast, was present in almost all individuals (n = 84, 90%), predominantly in the nares (n = 66, 71%). Using generalized estimating equation models, we observed that the odds of colonization were significantly and drastically reduced when was detected ( = .0001). After controlling for site, gender, and age, we identified that the odds of colonization were 80% less if was present (adjusted odds ratio, 0.20; 95% confidence interval, .09-.45; < .0001).
Taken together, we observed a lower prevalence of and MRSA colonization than has been previously reported in PLWH. In this cohort, colonization with was protective against colonization.
耐甲氧西林金黄色葡萄球菌（MRSA）的定植和感染对人类免疫缺陷病毒（HIV）感染者（PLWH）的影响尤为严重，特别是USA300和USA500克隆株。然而，流行病学、细菌学和免疫学危险因素对PLWH中MRSA感染过量的影响仍未完全明确。
在这项横断面研究中，我们确定了93名前往城市人类免疫缺陷病毒（HIV）诊所就诊的PLWH中MRSA定植的患病率和分子流行病学。参与者完成了一项结构化访谈，评估人口统计学信息和MRSA的危险因素。从鼻子、喉咙和腹股沟采集拭子，进行MRSA和金黄色葡萄球菌培养。
大多数参与者的HIV感染得到了良好控制（89例，96%的CD4>200）。36名（39%）个体在1个或更多身体部位被金黄色葡萄球菌定植，其中6名（6%）被MRSA定植。经常去健身房是金黄色葡萄球菌定植的危险因素，但不是MRSA携带的危险因素。相比之下，几乎所有个体（n = 84，90%）都存在凝固酶阴性葡萄球菌，主要存在于鼻腔（n = 66，71%）。使用广义估计方程模型，我们观察到当检测到凝固酶阴性葡萄球菌时，MRSA定植的几率显著且大幅降低（P = 0.0001）。在控制了部位、性别和年龄后，我们发现如果存在凝固酶阴性葡萄球菌，MRSA定植的几率降低80%（调整后的优势比，0.20；95%置信区间，0.09 - 0.45；P < 0.0001）。
总体而言，我们观察到PLWH中MRSA和金黄色葡萄球菌定植的患病率低于先前报道。在这个队列中，凝固酶阴性葡萄球菌定植对MRSA定植具有保护作用。
