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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
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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.

Ann Intern Med. 1999;130(3):221-225. doi:10.7326/0003-4819-130-3-199902020-00026
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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.





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