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Nasal Carriage of and Infection with Staphylococcus aureus in HIV-Infected Patients

M. Hong Nguyen, MD; Carol A. Kauffman, MD; Richard P. Goodman, MD; Cheryl Squier, RN; Robert D. Arbeit, MD; Nina Singh, MD; Marilyn M. Wagener, MPH; and Victor L. Yu, MD

2 February 1999 | Volume 130 Issue 3 | Pages 221-225

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.

Author and Article Information

From University of Pittsburgh Medical Center and Veterans Affairs Medical Center, Pittsburgh, Pennsylvania; University of Michigan Medical Center and Veterans Affairs Medical Center, Ann Arbor, Michigan; and Boston University Medical Center and Veterans Affairs Medical Center, Boston, Massachusetts.

Requests for Reprints: Victor L. Yu, MD, Infectious Disease Section (111), Veterans Affairs Medical Center, University Drive C, Pittsburgh, PA 15240; e-mail, vly+@pitt.edu.

Current Author Addresses: Dr. Nguyen: University of Florida College of Medicine, Box 100277, JHMHC, Gainesville, FL 32610.

Dr. Kauffman: Division of Infectious Diseases, Veterans Affairs Medical Center, 2215 Fuller Road, Ann Arbor, MI 48105.

Drs. Goodman and Arbeit: Veterans Affairs Medical Center, 150 S. Huntington Avenue, 111 ID, Boston, MA 02130.

Ms. Squier, Dr. Singh, Ms. Wagener, and Dr. Yu: Infectious Disease Section (111), Veterans Affairs Medical Center, University Drive C, Pittsburgh, PA 15240.

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