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Skin and Soft Tissue Infection in People Living With Human Immunodeficiency Virus in a Large, Urban, Public Healthcare System in Houston, Texas, 2009–2014
- Source :
- Clin Infect Dis
- Publication Year :
- 2019
- Publisher :
- Oxford University Press (OUP), 2019.
-
Abstract
- Background Skin and soft tissue infections (SSTIs) disproportionately impact patients with human immunodeficiency virus (HIV). Recent declines in the incidence of SSTIs have been noted in the non-HIV population. We sought to study the epidemiology and microbiology of SSTIs in a population of 8597 patients followed for HIV primary care in a large, urban county system from January 2009 to December 2014. Methods SSTIs were identified from the electronic medical record by use of International Classification of Diseases-9 billing codes. Charts were reviewed to confirm each patient’s diagnosis of acute SSTI and abstract culture and susceptibility data. We calculated the yearly SSTI incidences using Poisson regression with clustering by patient. Results There were 2202 SSTIs identified. Of 503 (22.8%) cultured SSTIs, 332 (66.0%) recovered Staphylococcus aureus as a pathogen, of which 287/332 (86.4%) featured S. aureus as the sole isolated organism. Among the S. aureus isolates that exhibited antibiotic susceptibilities, 231/331 (69.8%) were methicillin resistant, and the proportion did not change by year. The observed incidence of SSTI was 78.0 per 1000 person-years (95% confidence interval 72.9–83.4) and declined from 96.0 infections per 1000 person-years in 2009 to 56.5 infections per 1000 person-years in 2014 (P < .001). Other significant predictors of SSTI incidences in both univariate as well as multivariate analyses included a low CD4 count, high viral load, and not being a Spanish-speaking Hispanic. Conclusions SSTIs remain a significant problem in the outpatients living with HIV, although rates of SSTIs appear to have declined by approximately 40% between 2009 and 2014.
- Subjects :
- Methicillin-Resistant Staphylococcus aureus
0301 basic medicine
Microbiology (medical)
Staphylococcus aureus
medicine.medical_specialty
Multivariate analysis
030106 microbiology
Population
HIV Infections
medicine.disease_cause
03 medical and health sciences
symbols.namesake
0302 clinical medicine
Risk Factors
Internal medicine
Epidemiology
Humans
Medicine
030212 general & internal medicine
Poisson regression
education
Articles and Commentaries
education.field_of_study
business.industry
Soft Tissue Infections
Incidence (epidemiology)
HIV
Texas
Confidence interval
Anti-Bacterial Agents
Community-Acquired Infections
Infectious Diseases
symbols
Staphylococcal Skin Infections
business
Delivery of Health Care
Viral load
Subjects
Details
- ISSN :
- 15376591 and 10584838
- Volume :
- 70
- Database :
- OpenAIRE
- Journal :
- Clinical Infectious Diseases
- Accession number :
- edsair.doi.dedup.....0cb6f3ca8a7e995959161533cd9ae556
- Full Text :
- https://doi.org/10.1093/cid/ciz509