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

Vagish S. Hemmige, M. McNulty, E. Silverman, M. Z. David

Research output: Contribution to journalArticle

10 Citations (Scopus)

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

Fingerprint

Soft Tissue Infections
Methicillin-Resistant Staphylococcus aureus
Outpatients
HIV
Skin
Confidence Intervals
Lymphedema
Incidence
Medicaid
Immunologic Factors
CD4 Lymphocyte Count
Sexually Transmitted Diseases
Insurance
Viral Load
Psoriasis
African Americans
Cohort Studies
Catheters
Demography

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

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title = "Predictors of skin and soft tissue infections in HIV-infected outpatients in the community-associated methicillin-resistant Staphylococcus aureus era",
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.",
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T1 - Predictors of skin and soft tissue infections in HIV-infected outpatients in the community-associated methicillin-resistant Staphylococcus aureus era

AU - Hemmige, Vagish S.

AU - McNulty, M.

AU - Silverman, E.

AU - David, M. Z.

PY - 2014/1/1

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N2 - 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.

AB - 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.

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