Nasal carriage of and infection with Staphylococcus aureus in HIV-infected patients.

Abstract:

BACKGROUND:Staphylococcus aureus is a common cause of serious infection in patients infected with HIV. OBJECTIVES:To evaluate risk factors for and quantitative effect of S. aureus infection in HIV-infected patients, with special attention to nasal carriage. DESIGN:Prospective, multihospital cohort study. SETTING:Three tertiary care Veterans Affairs Medical Centers. PARTICIPANTS:231 ambulatory HIV-infected patients. RESULTS:Thirty-four percent of patients were nasal carriers of S. aureus. Of these patients, 38% were persistent carriers and 62% were intermittent carriers. Twenty-one episodes of infection occurred in 13 patients: Ten were bacteremias (including 2 cases of endocarditis), 1 was pneumonia, and 10 were cutaneous or subcutaneous infections. Seventeen (85%) of these episodes occurred in patients with CD4 counts less than 100 cells/mm3. Recurrent infections occurred in 3 of 7 patients who survived an initial S. aureus infection. The mortality rate was higher among patients with S. aureus infection than among those without infection (P = 0.03). Factors significantly associated with S. aureus infection were nasal carriage, presence of a vascular catheter, low CD4 count, and neutropenia. Molecular strain typing indicated that for 6 of 7 infected patients, the strain of S. aureus isolated from the infected sites was the same as that previously cultured from the nares. CONCLUSION:Nasal carriage is an important risk factor for S. aureus infection in HIV-infected patients. Controlled studies are indicated to determine whether eradication of nasal carriage in a selected subset of patients (for example, those with a low CD4 cell count) might prevent invasive S. aureus infection in patients with HIV infection.

journal_name

Ann Intern Med

authors

Nguyen MH,Kauffman CA,Goodman RP,Squier C,Arbeit RD,Singh N,Wagener MM,Yu VL

doi

10.7326/0003-4819-130-3-199902020-00026

subject

Has Abstract

pub_date

1999-02-02 00:00:00

pages

221-5

issue

3

eissn

0003-4819

issn

1539-3704

pii

199902020-00008

journal_volume

130

pub_type

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