July 29, 2014
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Patients with HIV highly vulnerable to MRSA colonization

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MRSA colonization appears to be present in 6.9% of HIV-infected patients, according to recent findings.

In a systematic literature review and meta-analysis, researchers conducted a search of the PubMed and Embase databases to identify clinical studies that reported the prevalence of MRSA colonization among patients with HIV. They analyzed the data in terms of the following factors: prior hospitalization, current ART, current use of trimethoprim-sulfamethoxazole, use of illicit drugs, and history of incarceration.

The researchers identified 1,899 published studies, 32 of which were considered appropriate for analysis. The studies included data on 6,558 HIV-infected patients.

MRSA carriage was observed in 6.9% (95% CI, 4.8-9.3) of the HIV-infected individuals; the analogous percentage across North American studies was 8.8% (95% CI, 6-12.2). Patients who had been hospitalized within the past 12 months had a higher risk for MRSA colonization (RR=3.11; 95% CI, 1.62-5.98), whereas those who were previously or currently incarcerated were at greater risk of being carriers (RR=1.77; 95% CI, 1.26-2.48). Current use of antiretroviral medications was not associated with increased risk for MRSA carriage (RR=1.02; 95% CI, 0.64-1.63), nor was the use of TMP-SMX (RR=1.45; 95% CI, 0.69-3.03).

Of the screening methods used, extranasal screening increased identification of MRSA colonization by at least 31.6% (95% CI, 15.8-50); groin screening increased detection by 19.3% (95% CI, 11.5-28.5); perirectal screening increased yield by 18.5% (95% CI, 7.4-33.2); and throat cultures increased detection by 17.5% (95% CI, 12-24).

According to the researchers, the findings underscore the importance of identifying MRSA colonization in patients with HIV, particularly through extranasal screening.

“Given that HIV-infected individuals are at increased risk for MRSA infection and that colonization has been associated with infection, these findings emphasize the need for evaluation and implementation of MRSA prevention strategies that focus on this highly vulnerable population,” the researchers wrote. “In this effort, specific attention should be drawn to the important burden of colonization in extranasal sites.”

Disclosure: The researchers report no relevant financial disclosures.