Methicillin-resistant Staphylococcus aureus nasal colonization among HIV-infected patients in Taiwan: prevalence, molecular characteristics and associated factors with nasal carriage

Abstract

Background: To evaluate nasal carriage, antibiotic susceptibility and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA), as well as the risk factors of MRSA colonization, in human immunodeficiency virus (HIV)-infected patients in northern Taiwan.Methods: From September 2014 to November 2015, HIV-infected patients seeking outpatient care at four hospitals were eligible for this study. A nasal specimen was obtained from each subject for the detection of S. aureus and a questionnaire was completed by each subject. MRSA isolates once identified were characterized.Results: Of 553 patients surveyed, methicillin-susceptible S. aureus (MSSA) was detected in 119 subjects (21.5%) and MRSA in 19 subjects (3.4%). Female gender, injection drug use, smoking, hepatitis C virus carrier, cancer and antibiotic use within one year were positively associated with MRSA colonization. By multivariate analysis, only cancer (adjust odds ratio (aOR) 7.78, [95% confidence interval (CI), 1.909-31.731]) and antibiotic use within one year (aOR 3.89, [95% CI, 1.219-12.433]) were significantly associated with MRSA colonization. Ten isolates were characterized as sequence type (ST) 59/staphylococcal chromosome cassette (SCC) IV or VT, endemic community strains in Taiwan, four isolates as ST 8/SCCmec IV (USA 300) and one isolate as ST 239/SCCmec IIIA, a hospital strain. All the community-associated MRSA isolates were susceptible to trimethoprim-sulfamethoxazole (TMP-SMX). Conclusions: Nasal MRSA carriage in HIV-infected patients seeking outpatient care was low (3.4%) in northern Taiwan. Most of the colonizing isolates were genetically endemic community strains and exhibited high susceptibility to TMP-SMX and fluoroquinolones. Cancer and antibiotic use within one year were associated with MRSA colonization.

Risk factors for methicillin-resistant Staphylococcus aureus colonization and infection in patients with human immunodeficiency virus infection: A systematic review and meta-analysis

“…A total of 31 studies, representing a total of 17 427 patients with HIV infection, were selected for the final meta-analysis. 26–56 The details of the literature search and study selection are summarized in a PRISMA flow diagram (Figure 1).…”

“…The baseline characteristics of the included studies and recruited patients are presented in Table 1. 26–56 Of the 31 included studies, eight had a cohort design, 17 had a cross-sectional design and the remaining six studies had a case–control design. These studies reported a total of 1410 MRSA colonization events and the events of MRSA colonization and infection that occurred in each study ranged from 6 to 252.…”

“…A total of 18 studies reported sex difference as a risk factor for MRSA colonization and infection in patients with HIV infection. 27,32,34,36,38–42,44–49,52,53,56 No significant difference was noted between males and females regarding the risk of MRSA colonization and infection in patients with HIV infection (OR 0.91; 95% CI 0.77, 1.07; P = 0.247; Figure 2) and nonsignificant heterogeneity across the included studies was detected ( I 2 = 10.8%; P = 0.326). When the study conducted by Popovich 2013 was excluded, 41 sensitivity analysis suggested men with HIV infection had a lower risk of MRSA colonization and infection than females with HIV infection (Figure 3A).…”

“…57 A total of 16 studies reported previous antibiotic therapy as a risk factor for MRSA colonization and infection in patients with HIV infection. [27][28][29]32,[35][36][37][38]40,43,47,[50][51][52][53]56 The pooled result indicated that previous antibiotic therapy was associated with an increased risk of MRSA colonization and infection (OR 2.69; 95% CI 2.09, 3.45; P < 0.001; Figure 6) and nonsignificant heterogeneity was detected among included studies (I 2 ¼ 19.5%; P ¼ 0.231). Sensitivity analysis indicated the pooled conclusion was stable after excluding any particular study (Figure 3C).…”

“…The number of studies that reported the association of current antibiotic use, skin lesions, intravenous device use, current trimethoprim-sulfamethoxazole (TMP-SMX) use, and an MRSA colonization history with the risk of MRSA colonization and infection was three, four, four, eight, and 27,32,34,36,[38][39][40][41][42][44][45][46][47][48][49]52,53,56 six, respectively (Figure 10). [26][27][28][29][32][33][34][35]37,38,40,47,48,51,55 Skin lesions (OR 2.02; 95% CI 1.15, 3.55; P ¼ 0.015), intravenous device use (OR 2.61; 95% CI 1.59, 4.29; P < 0.001) and an MRSA colonization history (OR 6.30; 95% CI 2.50, 15.90; P < 0.001) were associated with an increased risk of MRSA colonization and infection, whereas the current use of antibiotics was associated with a reduced risk of MRSA colonization and infection (OR 0.13; 95% CI 0.05, 0.32; P < 0.001).…”