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MRSA Bloodstream Infections Occur More Frequently in HIV-Infected Patients With Low CD-4 Count: Presented at CROI

By Ed Susman

DENVER, CO -- February 7, 2006 -- In the first study of how methicillin-resistant Staphylococcus aureus (MRSA) affects patients coinfected with human immunodeficiency virus (HIV) in the United States, researchers were able to pinpoint individuals at risk of complicated MRSA bloodstream infections.

In a poster presentation here February 6^th at the 13^th Conference on Retroviruses and Opportunistic Infections (CROI), Matthew Burkey, a fourth year medical student at Johns Hopkins University School of Medicine in Baltimore, Maryland, reported that previous studies of HIV and MRSA had been performed only in Europe.

Between 2000 and 2003, he identified 60 patients with HIV and bloodstream MRSA and matched them with 240 HIV-infected patients who also had MRSA but did not progress to have a bloodstream infection.

"The greatest risk of having that MRSA infection spread to the blood occurred in HIV-infected patients with CD-4 positive cells counts below 50 cells/mm³," said Burkey. Compared with patients who had higher CD4-positive cells counts, the risk of suffering bacteremia was 25 times greater in the patients with the lower CDE-4 counts. That difference was statistically significant at the P < .05 level.

Burkey, who coauthored the study with Kelly Gebo, MD, assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland, said that there were other risk factors that contributed to the development of bloodstream infection. For example, patients undergoing dialysis for end-stage kidney disease had an 18-fold increased risk; being an IV drug user gave individuals a 6-fold risk; and patients with high baseline HIV anemia had a 3-fold risk. Those differences were statistically significant at the P < .05 level.

Burkey noted that both the incidence and proportion of patients with HIV/MRSA coinfection with bloodstream infections was rapidly increasing. In the 4-year study period, the number of cases rose from 4 in 2000 to 10 in 2003, and the proportion of those who developed bloodstream infections rose from 15% in 2000 to 45% in 2003.

"These observations suggest that the antibiotic vancomycin should be included in the empiric treatment of presumed sepsis in HIV-infected inpatients," Burkey said.


[Presentation title: The Incidence of and Risk Factors for MRSA Bacteremia in an Urban HIV Cohort in the HAART Era. Abstract 789]

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