Recurrent skin and soft tissue infections in HIV-infected patients during a 5-year period: incidence and risk factors in a retrospective cohort study

Abstract

BackgroundSkin and soft tissue infections (SSTIs) are common in the era of community-associated methicillin resistant Staphylococcus aureus among HIV-infected patients. Recurrent infections are frequent. Risk factors for recurrence after an initial SSTI have not been well-studied.MethodsRetrospective cohort study, single center, 2005–2009. Paper and electronic medical records were reviewed by one of several physicians. Subjects with initial SSTI were followed until the time of SSTI recurrence. Standard descriptive statistics were calculated to describe the characteristics of subjects who did and did not develop a recurrent SSTI. Kaplan-Meier methods were used to estimate the risk of recurrent SSTI. A Cox regression model was developed to identify predictors of SSTI recurrence.Results133 SSTIs occurred in 87 individuals. 85 subjects were followed after their initial SSTI, of whom 30 (35.3 %) had a recurrent SSTI in 118.3 person-years of follow-up, for an incidence of second SSTI of 253.6 SSTIs/1000 person-years (95 % CI 166.8-385.7). The 1-year Kaplan-Meier estimated risk of a second SSTI was 29.2 % (95 % CI 20.3–41.0 %), while the 3-year risk was 47.0 % (95 % CI 34.4–61.6 %). Risk factors for recurrent SSTI in a multivariable Cox regression model were non-hepatitis liver disease (HR 3.44; 95 % CI 1.02–11.5; p = 0.05), the presence of an intravenous catheter (HR 6.50; 95 % CI 1.47–28.7; p = 0.01), and a history of intravenous drug use (IVDU) (HR 2.80; 95 % CI 1.02-7.65; p = 0.05); African-American race was associated with decreased risk of recurrent SSTI (HR 0.12; 95 % CI 0.04-0.41; p < 0.01). Some evidence was present for HIV viral load ≥ 1000 copies/mL as an independent risk factor for recurrent SSTI (HR 2.21; 95 % CI 0.99-4.94; p = 0.05). Hemodialysis, currently taking HAART, CD4+ count, trimethoprim-sulfamethoxazole or azithromycin use, initial SSTI type, diabetes mellitus, incision and drainage of the original SSTI, or self-report of being a man who has sex with men were not associated with recurrence.ConclusionOf HIV-infected patients with an SSTI, nearly 1/3 had a recurrent SSTI within 1 year. Risk factors for recurrent SSTI were non-hepatitis liver disease, intravenous catheter presence, a history of IVDU, and non-African-American race. Low CD4+ count was not a significant risk factor for recurrence.

Prevalence of nasal colonization by methicillin-resistant Staphylococcus aureus in outpatients living with HIV/AIDS in a Referential Hospital of the Northeast of Brazil

“…Our study also sought to evaluate the association between nasal colonization by MRSA and co-morbidities such as diabetes, chronic liver disease, cancer and sexually transmitted diseases, but was unable to establish any significant associations. Hemmige and collaborators [ 19 ] observed that none of these variables was associated with nasal colonization by MRSA. A similar study conducted in Iran stressed that there was no association between MRSA nasal colonization and cigarette smoking or prior use of antibiotics [ 5 ].…”

Treatment of acute bacterial skin and skin structure infection with single-dose dalbavancin in persons who inject drugs

“…In hospitalized patients, nonadherence to oral antibiotics after discharge is an important predictor of poor outcome and relapse 13. In a community setting, adherence can be further compromised; PWID are at higher risk of recurrent ABSSSIs14 and more likely to have severe disease with adverse outcomes 15,22. Reasons for outpatient antibiotic failure in PWID also include missed follow-up visits, noncompliance with antibiotic therapy, and documented line manipulation 22.…”

“…Infectious diseases are a major health issue in PWID, who typically seek medical attention later in their disease course 13. PWID are at higher risk of recurrent ABSSSIs,7,14 necrotizing fasciitis, and infective endocarditis due to spread from skin and soft tissue abscesses into the bloodstream, and they are more likely to experience adverse outcomes associated with this disease 15,16. Medical care for patients with a history of injection drug use is complicated by medical, social, and economic issues that affect adherence 13.…”

Recurrent Event Analysis of Coronary Artery Stenosis in Patients Undergoing Angioplasty

“…One of the statistical methods used for analyzing timeto-event data in the presence of censored data is the survival analysis that is mostly used for investigating the survival and hazard rates of patients based on different covariates (10). In the survival analysis in many medical situations, patients experience recurrent events such as the development of new tumors in cancer patients, the occurrence of ischemic attacks in coronary artery disease patients, re-hospitalization, and the incidence of recurrent opportunistic infections in HIV-positive patients (11)(12)(13)(14). In the above-mentioned examples, the recurrent events of an individual are possible given the basic characteristics of the individual.…”