Recurrent skin and soft tissue infections in HIV-infected patients during a 5-year period: incidence and risk factors in a retrospective cohort study
Identifieur interne : 000F17 ( Pmc/Checkpoint ); précédent : 000F16; suivant : 000F18Recurrent skin and soft tissue infections in HIV-infected patients during a 5-year period: incidence and risk factors in a retrospective cohort study
Auteurs : Vagish Hemmige [États-Unis] ; Moira Mcnulty [États-Unis] ; Ethan Silverman [États-Unis] ; Michael Z. David [États-Unis]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2015.
Abstract
Skin and soft tissue infections (SSTIs) are common in the era of community-associated methicillin resistant
Retrospective cohort study, single center, 2005–2009. Paper and electronic medical records were reviewed by one of several physicians. Subjects with initial SSTI were followed until the time of SSTI recurrence. Standard descriptive statistics were calculated to describe the characteristics of subjects who did and did not develop a recurrent SSTI. Kaplan-Meier methods were used to estimate the risk of recurrent SSTI. A Cox regression model was developed to identify predictors of SSTI recurrence.
133 SSTIs occurred in 87 individuals. 85 subjects were followed after their initial SSTI, of whom 30 (35.3 %) had a recurrent SSTI in 118.3 person-years of follow-up, for an incidence of second SSTI of 253.6 SSTIs/1000 person-years (95 % CI 166.8-385.7). The 1-year Kaplan-Meier estimated risk of a second SSTI was 29.2 % (95 % CI 20.3–41.0 %), while the 3-year risk was 47.0 % (95 % CI 34.4–61.6 %). Risk factors for recurrent SSTI in a multivariable Cox regression model were non-hepatitis liver disease (HR 3.44; 95 % CI 1.02–11.5;
Of HIV-infected patients with an SSTI, nearly 1/3 had a recurrent SSTI within 1 year. Risk factors for recurrent SSTI were non-hepatitis liver disease, intravenous catheter presence, a history of IVDU, and non-African-American race. Low CD4+ count was not a significant risk factor for recurrence.
Url:
DOI: 10.1186/s12879-015-1216-1
PubMed: 26503616
PubMed Central: 4620745
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Recurrent skin and soft tissue infections in HIV-infected patients during a 5-year period: incidence and risk factors in a retrospective cohort study</title>
<author><name sortKey="Hemmige, Vagish" sort="Hemmige, Vagish" uniqKey="Hemmige V" first="Vagish" last="Hemmige">Vagish Hemmige</name>
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<author><name sortKey="Mcnulty, Moira" sort="Mcnulty, Moira" uniqKey="Mcnulty M" first="Moira" last="Mcnulty">Moira Mcnulty</name>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Skin and soft tissue infections (SSTIs) are common in the era of community-associated methicillin resistant <italic>Staphylococcus aureus</italic>
among HIV-infected patients. Recurrent infections are frequent. Risk factors for recurrence after an initial SSTI have not been well-studied.</p>
</sec>
<sec><title>Methods</title>
<p>Retrospective cohort study, single center, 2005–2009. Paper and electronic medical records were reviewed by one of several physicians. Subjects with initial SSTI were followed until the time of SSTI recurrence. Standard descriptive statistics were calculated to describe the characteristics of subjects who did and did not develop a recurrent SSTI. Kaplan-Meier methods were used to estimate the risk of recurrent SSTI. A Cox regression model was developed to identify predictors of SSTI recurrence.</p>
</sec>
<sec><title>Results</title>
<p>133 SSTIs occurred in 87 individuals. 85 subjects were followed after their initial SSTI, of whom 30 (35.3 %) had a recurrent SSTI in 118.3 person-years of follow-up, for an incidence of second SSTI of 253.6 SSTIs/1000 person-years (95 % CI 166.8-385.7). The 1-year Kaplan-Meier estimated risk of a second SSTI was 29.2 % (95 % CI 20.3–41.0 %), while the 3-year risk was 47.0 % (95 % CI 34.4–61.6 %). Risk factors for recurrent SSTI in a multivariable Cox regression model were non-hepatitis liver disease (HR 3.44; 95 % CI 1.02–11.5; <italic>p</italic>
= 0.05), the presence of an intravenous catheter (HR 6.50; 95 % CI 1.47–28.7; <italic>p</italic>
= 0.01), and a history of intravenous drug use (IVDU) (HR 2.80; 95 % CI 1.02-7.65; <italic>p</italic>
= 0.05); African-American race was associated with decreased risk of recurrent SSTI (HR 0.12; 95 % CI 0.04-0.41; <italic>p</italic>
< 0.01). Some evidence was present for HIV viral load ≥ 1000 copies/mL as an independent risk factor for recurrent SSTI (HR 2.21; 95 % CI 0.99-4.94; <italic>p</italic>
= 0.05). Hemodialysis, currently taking HAART, CD4+ count, trimethoprim-sulfamethoxazole or azithromycin use, initial SSTI type, diabetes mellitus, incision and drainage of the original SSTI, or self-report of being a man who has sex with men were not associated with recurrence.</p>
</sec>
<sec><title>Conclusion</title>
<p>Of HIV-infected patients with an SSTI, nearly 1/3 had a recurrent SSTI within 1 year. Risk factors for recurrent SSTI were non-hepatitis liver disease, intravenous catheter presence, a history of IVDU, and non-African-American race. Low CD4+ count was not a significant risk factor for recurrence.</p>
</sec>
</div>
</front>
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</author>
<author><name sortKey="Rabeneck, L" uniqKey="Rabeneck L">L Rabeneck</name>
</author>
<author><name sortKey="Hartman, C" uniqKey="Hartman C">C Hartman</name>
</author>
</analytic>
</biblStruct>
</listBibl>
</div1>
</back>
</TEI>
<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Infect Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">BMC Infect. Dis</journal-id>
<journal-title-group><journal-title>BMC Infectious Diseases</journal-title>
</journal-title-group>
<issn pub-type="epub">1471-2334</issn>
<publisher><publisher-name>BioMed Central</publisher-name>
<publisher-loc>London</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26503616</article-id>
<article-id pub-id-type="pmc">4620745</article-id>
<article-id pub-id-type="publisher-id">1216</article-id>
<article-id pub-id-type="doi">10.1186/s12879-015-1216-1</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Recurrent skin and soft tissue infections in HIV-infected patients during a 5-year period: incidence and risk factors in a retrospective cohort study</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Hemmige</surname>
<given-names>Vagish</given-names>
</name>
<address><email>vagish.hemmige@bcm.edu</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>McNulty</surname>
<given-names>Moira</given-names>
</name>
<address><email>moira.mcnulty@uchospitals.edu</email>
</address>
<xref ref-type="aff" rid="Aff2"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Silverman</surname>
<given-names>Ethan</given-names>
</name>
<address><email>ejsilve@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff2"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>David</surname>
<given-names>Michael Z.</given-names>
</name>
<address><email>mdavid@medicine.bsd.uchicago.edu</email>
</address>
<xref ref-type="aff" rid="Aff2"></xref>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<aff id="Aff1"><label></label>
Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, 6620 Main, Suite 1375, Houston, TX 77030 USA</aff>
<aff id="Aff2"><label></label>
Department of Medicine, University of Chicago, 5841 S Maryland, Chicago, IL 60637 USA</aff>
<aff id="Aff3"><label></label>
Department of Pediatrics and Department of Public Health Sciences, University of Chicago, 5841 S. Maryland Ave. MC6054, Chicago, 60637 IL USA</aff>
</contrib-group>
<pub-date pub-type="epub"><day>26</day>
<month>10</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>26</day>
<month>10</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="collection"><year>2015</year>
</pub-date>
<volume>15</volume>
<elocation-id>455</elocation-id>
<history><date date-type="received"><day>17</day>
<month>3</month>
<year>2015</year>
</date>
<date date-type="accepted"><day>14</day>
<month>10</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-statement>© Hemmige et al. 2015</copyright-statement>
<license license-type="OpenAccess"><license-p><bold>Open Access</bold>
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>
) applies to the data made available in this article, unless otherwise stated.</license-p>
</license>
</permissions>
<abstract id="Abs1"><sec><title>Background</title>
<p>Skin and soft tissue infections (SSTIs) are common in the era of community-associated methicillin resistant <italic>Staphylococcus aureus</italic>
among HIV-infected patients. Recurrent infections are frequent. Risk factors for recurrence after an initial SSTI have not been well-studied.</p>
</sec>
<sec><title>Methods</title>
<p>Retrospective cohort study, single center, 2005–2009. Paper and electronic medical records were reviewed by one of several physicians. Subjects with initial SSTI were followed until the time of SSTI recurrence. Standard descriptive statistics were calculated to describe the characteristics of subjects who did and did not develop a recurrent SSTI. Kaplan-Meier methods were used to estimate the risk of recurrent SSTI. A Cox regression model was developed to identify predictors of SSTI recurrence.</p>
</sec>
<sec><title>Results</title>
<p>133 SSTIs occurred in 87 individuals. 85 subjects were followed after their initial SSTI, of whom 30 (35.3 %) had a recurrent SSTI in 118.3 person-years of follow-up, for an incidence of second SSTI of 253.6 SSTIs/1000 person-years (95 % CI 166.8-385.7). The 1-year Kaplan-Meier estimated risk of a second SSTI was 29.2 % (95 % CI 20.3–41.0 %), while the 3-year risk was 47.0 % (95 % CI 34.4–61.6 %). Risk factors for recurrent SSTI in a multivariable Cox regression model were non-hepatitis liver disease (HR 3.44; 95 % CI 1.02–11.5; <italic>p</italic>
= 0.05), the presence of an intravenous catheter (HR 6.50; 95 % CI 1.47–28.7; <italic>p</italic>
= 0.01), and a history of intravenous drug use (IVDU) (HR 2.80; 95 % CI 1.02-7.65; <italic>p</italic>
= 0.05); African-American race was associated with decreased risk of recurrent SSTI (HR 0.12; 95 % CI 0.04-0.41; <italic>p</italic>
< 0.01). Some evidence was present for HIV viral load ≥ 1000 copies/mL as an independent risk factor for recurrent SSTI (HR 2.21; 95 % CI 0.99-4.94; <italic>p</italic>
= 0.05). Hemodialysis, currently taking HAART, CD4+ count, trimethoprim-sulfamethoxazole or azithromycin use, initial SSTI type, diabetes mellitus, incision and drainage of the original SSTI, or self-report of being a man who has sex with men were not associated with recurrence.</p>
</sec>
<sec><title>Conclusion</title>
<p>Of HIV-infected patients with an SSTI, nearly 1/3 had a recurrent SSTI within 1 year. Risk factors for recurrent SSTI were non-hepatitis liver disease, intravenous catheter presence, a history of IVDU, and non-African-American race. Low CD4+ count was not a significant risk factor for recurrence.</p>
</sec>
</abstract>
<kwd-group xml:lang="en"><title>Keywords</title>
<kwd>HIV</kwd>
<kwd>Epidemiology</kwd>
<kwd>Skin and soft tissue infections</kwd>
<kwd>MRSA</kwd>
</kwd-group>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Author(s) 2015</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>États-Unis</li>
</country>
<region><li>Illinois</li>
<li>Texas</li>
</region>
<settlement><li>Chicago</li>
</settlement>
</list>
<tree><country name="États-Unis"><region name="Texas"><name sortKey="Hemmige, Vagish" sort="Hemmige, Vagish" uniqKey="Hemmige V" first="Vagish" last="Hemmige">Vagish Hemmige</name>
</region>
<name sortKey="David, Michael Z" sort="David, Michael Z" uniqKey="David M" first="Michael Z." last="David">Michael Z. David</name>
<name sortKey="David, Michael Z" sort="David, Michael Z" uniqKey="David M" first="Michael Z." last="David">Michael Z. David</name>
<name sortKey="Mcnulty, Moira" sort="Mcnulty, Moira" uniqKey="Mcnulty M" first="Moira" last="Mcnulty">Moira Mcnulty</name>
<name sortKey="Silverman, Ethan" sort="Silverman, Ethan" uniqKey="Silverman E" first="Ethan" last="Silverman">Ethan Silverman</name>
</country>
</tree>
</affiliations>
</record>
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