Methicillin-Resistant Staphylococcus aureus Infections in Human Immunodeficiency Virus-Infected Children and Adolescents

Abstract EN

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.