Predictors of skin and soft tissue infections in HIV-infected outpatients in the community-associated methicillin-resistant Staphylococcus aureus era

V. Hemmige, M. McNulty, E. Silverman, M. Z. David

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Skin and soft tissue infections (SSTIs) are common in the era of community-associated methicillin-resistant Staphylococcus aureus (MRSA) among human immunodeficiency virus (HIV)-infected patients, but the risk factors are not well defined. We sought to elucidate the risk factors for SSTI occurrence in an HIV cohort. This investigation was a retrospective, single-center cohort study, carried out during the period 2005–2009. In this cohort of 511 HIV-infected individuals, 133 SSTIs occurred in 87 individuals over 1,228.6 person-years of follow-up, for an incidence of 108 SSTIs/1,000 person-years [95 % confidence interval (CI) 87–135]. The incidence declined significantly over time (p < 0.01). In a multivariable Cox regression, diabetes [hazard ratio (HR) 2.01; 95 % CI 1.04–3.89], psoriasis (HR 5.77; 95 % CI 1.86–17.9), lymphedema (HR 6.84; 95 % CI 2.59–18.1), intravenous catheter presence (HR 3.38; 95 % CI 1.00–11.5), and HIV viral load greater than 1,000 copies/mL (HR 2.13; 95 % CI 1.33–3.41) were most strongly associated with development of the first SSTI. Trends toward an association between SSTI risk and Medicaid insurance (HR 1.67; 95 % CI 0.98–2.83) and sexually transmitted disease during follow-up (HR 1.66; 0.99–2.78) were present. CD4+ count and trimethoprim–sulfamethoxazole use were not associated with SSTI risk. HIV-infected individuals are at high risk for SSTIs. In a primarily urban, African-American cohort, we found that a number of immunologic and demographic factors were associated with SSTI risk.

Original languageEnglish (US)
Pages (from-to)339-347
Number of pages9
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume34
Issue number2
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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