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AIDS Res Treat. 2012; 2012: 627974.
Published online Sep 12, 2012. doi:  10.1155/2012/627974
PMCID: PMC3447349
Methicillin-Resistant Staphylococcus aureus Infections in Human Immunodeficiency Virus-Infected Children and Adolescents
George K. Siberry, 1 * Toni Frederick, 2 Patricia Emmanuel, 3 Mary E. Paul, 4 Beverly Bohannon, 5 Travis Wheeling, 6 Theresa Barton, 7 Mobeen H. Rathore, 8 and Kenneth L. Dominguez 5
1Pediatric, Adolescent & Maternal AIDS (PAMA) Branch, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD 20892-7510, USA
2Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, CA 90033, USA
3Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL 33606, USA
4Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
5Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
6Northrop Grumman Inc., Atlanta, GA 30345, USA
7Department of Pediatric Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
8Department of Pediatric Infectious Diseases and Immunology, University of Florida and Wolfson Children's Hospital, and University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES), Jacksonville, FL 32209, USA
*George K. Siberry: siberryg/at/mail.nih.gov
Academic Editor: Peter Mariuz
Received May 7, 2012; Accepted July 5, 2012.
Abstract
Background. Methicillin-resistant Staphylococcus aureus (MRSA) infection incidence has increased in healthy US children. Our objective was to evaluate MRSA incidence and correlates in HIV-infected youth. Methods. The CDC-sponsored LEGACY study is a US multicenter chart abstraction study of HIV-infected youth. We identified MRSA infections among participants with ≥1 visit during 2006. We used bivariate and multivariable analyses to compare sociodemographic and HIV clinical factors between MRSA cases and noncases. Results. Fourteen MRSA infections (1 invasive, 12 soft tissue, 1 indeterminate) occurred among 1,813 subjects (11.1 infections/1,000 patient-years (PY), 95% CI: 11.06–11.14). Most (86%) isolates were clindamycin susceptible. Compared with noncases, MRSA cases were more likely older (17 versus 14 years), black (100% versus 69%), behaviorally HIV infected (43% versus 17%), and in Maryland (43% versus 7%) and had viral loads (VL) >1000 copies/mL (86% versus 51%) and lower mean CD4% (18% versus 27%) (all P < 0.05). In multivariate analysis, independent risk factors were Maryland care site (adjusted odds ratio (aOR) = 9.0), VL >1000 copies/mL (aOR = 5.9), and black race (aOR undefined). Conclusions. MRSA occurred at a rate of 11.1 infections/1,000 PY in HIV-infected youth but invasive disease was uncommon. Geographic location, black race, and increased VL, but not immunosuppression, were independently associated with MRSA risk.
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