Table 3.
Characteristics of the nine selected studies involving HIV patients with colonization and/or infection by Staphylococcus aureus.
| Type of study (country; authors) | Category (score) | Sample size | Clinical source(s) | Factors associated with colonization and/or infection* by MRSA | Phenotypic analysis of isolates | Molecular analysis and virulence/resistance genes investigated | Susceptibility test(s) | Antibiotic resistance rates for S. aureus isolates |
| Case-control(Italy; Tumbarello et al., 2002) | A (8) | 4,674 HIV-infected patients/129 S. aureus/41 MRSA/88 MSSA | Blood | Nosocomial episodes, previous antibiotic therapy and/or bacterial infections | API® test ID 32 STAPH | ND | MIC | CLI 39%; MCL 57%; MET 32%; PEN 73%; QUI 49%; TMP/SXT 70%; VAN 0% |
| Case-control (USA; Hidron et al., 2005) | A (9) | 726 patients/81 HIV-infected patients (14 MRSA)/645 HIV-negative (39 MRSA) | Anterior nares | No antimicrobial use in the past three months before the current admission (only for HIV-infected patients) | SMA; latex agglutination test | PFGE; SCCmec typing; PVL | Disk diffusion; OAS | CLI 32%; DOX 10%; GEN 23%; MCL 92.5%; OXA 100%; QUI 83%; RIF 20%; TMP/SXT 21%; VAN 0% (data from MRSA isolates, independent of patient classification) |
| Retrospective case-control (Italy; Drapeau et al., 2007) | A (8) | 3,000 patients/28 MRSA | Blood; skin and soft tissue; sputum, bronchoalveolar lavage and pleural fluids | T CD4+ T lymphocyte counts <200 cells/μl; previous hospitalization; an invasive procedure in the previous year | ND | ND | Automated system | ND |
| Retrospective (USA; Burkey et al., 2008) | A (8) | 4,607 patients/216 S. aureus/94 MRSA | Blood | Intravenous drug use; CD4+ T lymphocyte counts <200 cells/μl; end-stage renal disease | ND | ND | OAS | ND |
| Prospective (USA; Shet et al., 2009) | A (8) | 107 patients/41 S. aureus/21 MRSA | Anterior nares | Previous antibiotic therapy | SMA; latex agglutination test | PFGE; SCCmec typing; PVL, ACME, spa, mecA, and mupA genes | MIC | CLI 43%; MCL 100%; MUP 39%; QUI 95%; TET 24%; TMP/SXT 5% |
| Experimental, randomized controlled trial, prospective (USA; Gordon et al., 2010) | A (8) | 191 S. aureus/27% MRSA | Anterior nares | Relapse of drug or alcohol use within the previous month; previous antibiotic therapy | SMA; latex agglutination test | PFGE | MIC; disk diffusion | CLI 83%; FOX 20%; GEN 9%; MCL 95%; OXA 27%; PEN 99%; QUI 45%; RIF 2%; TET 16%; TMP/SXT 89%; VAN 0% |
| Retrospective et al., 2010) | A (8) | 900 patients/72 MRSA | Skin or soft tissue and normally sterile sites | Previous antibiotic therapy and/or hospitalization; CD4+ T lymphocyte counts <200 cells/μl; drug use; hepatitis B co-infection; OI in the previous year; alternative housing**; incarceration; alcohol abuse | ND | PFGE | ND | TMP/STX 2% |
| Observational (USA; Popovich et al., 2013) | A (8) | 745 patients/374 HIV-infected (74 MRSA)/371 HIV-negative (41 MRSA) | Nares; throat; bilateral axillae; bilateral inguinal regions; peri-rectal area and a chronic wound | Incarceration; male gender | ChromID MRSA; latex agglutination | PFGE | Disk diffusion | ND |
| Cohort (USA; Farley et al., 2013) | A (8) | 498 patients/68 HIV-infected (10 MRSA)/430 HIV-negative (20 MRSA) | Anterior nares; axilla and wound | History of or current abscess; isolation outside the hospital unit; HIV infection (data from all patients, independent of whether they were infected with HIV) | Gram stain; catalase; latex agglutination test | tufB, nuc, mecA, mupA, ileS-2 genes, PVL, TSST-1; PFGE; MLST; an automated platform for pathogen identification and strain typing | CHROMagar MRSA; automated system | TMP/STX 0%; MUP 7.7% (data from MRSA isolates, independent of patient classification) |
Factors for which odds ratios and 95% confidence intervals were calculated. **Includes patients residing in personal-care homes, nursing homes, long-term care facilities, and correctional facilities as well as those who were homeless. MRSA: methicillin-resistant S. aureus; HIV: human immunodeficiency virus; OI: opportunistic infection; SMA: culture in mannitol salt agar; PFGE: pulsed-field gel electrophoresis; PCR: polymerase chain reaction; PVL: Panton-Valentine leukocidin; TSST1: toxic shock toxin 1; ACME: arginine catabolic mobile element; MIC: minimum inhibitory concentration; CLI: clindamycin; DOX: doxycycline; FOX: cefoxitin; GEN: gentamicin; MCL: macrolides; MET: methicillin; MUP: mupirocin; OXA: oxacillin; PEN: penicillin; QUI: quinolones; RIF: rifampin; TET: tetracycline; TMP/STX: trimethoprim/sulfamethoxazole; VAN: vancomycin; ND: not determined; OAS: oxacillin agar screening.