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MRSA colonization 'not currently a problem' among patients with HIV in Spain
Community-associated MRSA colonization was not determined to be “a problem” in a cohort of patients with HIV in Barcelona, although Staphylococcus aureus colonization was present in one-third of patients, according to findings published in BMC Infectious Diseases.
“Although data on MRSA carriage in HIV-infected individuals in Europe are scarce, lower prevalence rates have been reported (0%-2.8%) and the findings in our series are consistent with reports from other European studies,” the authors wrote. “Our data contrast with most reports from the U.S.A., where a significant association between HIV infection and MRSA colonization has been well documented.”
Arkaitz Imaz, MD, of the HIV unit in the infectious diseases department at the Hospital Universitari de Bellvitge and the L’Hospitalet de Llobregat in Barcelona, and fellow researchers evaluated S. aureus colonization in 190 patients from an outpatient HIV clinic. Participants were mostly men (83%) and median age was 45 years. Most patients were on ART (96%) and many had an undetectable plasma viral load (80%). The study population included injection drug users (39%), men who have sex with men (32%) and heterosexuals (26%).
The researchers obtained nasal swab specimens from 190 patients and pharyngeal swab specimens from 110 patients for staphylococcal culture.
“All MRSA isolates were screened for Panton-Valentine leukocidin genes,” the researchers wrote. Data related to HIV infection and epidemiological characteristics identified as risk factors for health care-associated MRSA or CA-MRSA were determined through medical records and patient questionnaires.
MRSA colonization was detected in three patients. Nasal colonization was observed in two of 190 patients (1%) and pharyngeal colonization was noted in two of 110 patients (2%).
All MRSA isolates belonged to typical HA-associated clones. Among patients with MRSA colonization, two had risk factors for nosocomial acquisition. Two of the isolates were identified as ST146 and ST125, part of Clonal Complex 5; both carried staphylococcal chromosomal cassette mec IV. The isolate from the third patient was not available for molecular studies, but the patient was found to have no apparent risk factors for HA-MRSA; the antibiotic resistance pattern observed in this patient – resistance to erythromycin and ciprofloxacin – was identical to the dominant HA-MRSA lineage.
Colonization with methicillin-susceptible S. aureus was observed in 62 of 190 nasal samples (32.6%) and three of 110 pharyngeal samples (2.7%). Only one in three patients was found to be an exclusive MSSA pharyngeal carrier.
“None of the risk factors analyzed, including those related to demographics, HIV acquisition route, HIV control, health care-related conditions and other epidemiologic conditions, [were] statistically associated with MSSA colonization in either the univariate or multivariate analyses,” the researchers wrote.
“Our data suggest that CA-MRSA colonization is not currently a problem in HIV-infected individuals in our area,” the researchers concluded. “We recently reported a series of MRSA infection in HIV-infected patients in Spain in which we detected a higher risk for MRSA infection among individuals with poorly controlled HIV infection and immigrants (mostly
South Americans). Nevertheless, the overall prevalence was still lower than that reported for the U.S.A. The absence of CA-MRSA colonization in HIV-infected individuals in our area could partly explain the low rate of CA-MRSA infection in this population.” – by Julia Ernst, MS
Disclosure: The authors report no relevant financial disclosures. This study was partially funded by the Instituto de Salud Carlos III (Subdirección General de Evaluación), the European Regional Development Fund and the RD12/0017/0013 project within the Spanish Research, Development and Innovation Plan.