Increased Risk for MRSA Skin and Soft Tissue Infections Among HIV-Infected Persons

Nancy F. Crum-Cianflone, MD, MPH

Disclosures

January 15, 2010

Take-Home Points

  • HIV-infected persons presenting with SSTIs should be evaluated for MRSA because this population has a higher rate of both MRSA colonization and infection than the general population. In this patient, lack of adherence to both antiretroviral therapy and prophylaxis for opportunistic infections probably contributed to the severity of the soft tissue infection described here.

  • MRSA SSTIs should be managed with incision and drainage of any infectious collections. In this patient, the need for prompt surgical intervention was clear even before magnetic resonance imaging.

  • Culture specimens should be obtained in all cases to guide antimicrobial therapy. Antibiotics with MRSA activity should be considered, given the high rate of these infections in this population, with adjustments based on culture results. In this patient, the MRSA was susceptible to only 1 of the initial 3 empiric antibiotics initially administered.

  • HIV-infected persons with a history of MRSA infections are at high risk for the development of recurrent infections. These include the development of complicated infections, including necrotizing soft-tissue infections, which can rapidly become life- or limb-threatening as occurred in this patient.

  • Strategies for preventing MRSA infection in the HIV population are currently undefined. Prospective studies are underway to evaluate methods to reduce MRSA carriage and infections in this population.

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