Methicilin resistant staphylococcus aureus skin, soft tissue infection among HIV infected individuals attending HIV care and treatment clinics in Dar es salaam city, Tanzania

Abstract

ABSTRACT Back ground: Methicilin Resistance Staphylococcus aureus (MRSA) is found worldwide. HIV infection is a known risk factor for the development of MRSA infections and HIV infection may also increase the risk of recurrent disease. HIV infection has been associated with an increased incident of S. aureus skin and/or soft infection and nasal colonization with S. aureus in most patients. Objective To determine the prevalence of MRSA skin, soft tissue infections and nasal carriage among HIV infected adults attending HIV care and treatment clinics in Dar es Salaam, Tanzania. Methods: Study design and settings: A cross sectional study was conducted in all three district hospitals available in Dar; the HIV clinics at Amana hospital in Ilala district, Temeke hospital, in Temeke district, Mwananyamala hospital in Kinondoni district and Muhimbili National hospital, which is a tertiary care hospital located in Ilala Dar es Salaam. Patients were consecutively recruited into the study until the calculated sample size was achieved. A standard questionnaire was used to collect demographic data, and other MRSA related risk factors that included prior use of co-trimoxazole, prior use of antibiotics other than cotrimoxazole, history of prior hospital admission, family history of skin infection, known cases of Diabetes mellitus, malignancy, chronic renal failure, on dialysis. Physical examination was performed that included inspection for soft tissue infections and nasal swabs were collected from all HIV infected patients included in the study. Additionally swabs or pus aspirate was collected from all patients with skin and or soft tissue infections for the examination of MRSA. Resistance testing was performed for Staphylococcus aureus, MRSA was defined as Staphylococcus aures resistant to methicillin and cefoxitin. 10 Results: A total of 271 HIV infected patients were recruited into the study, 107 (39.5%) were males and 164 (60.5%) were females. The prevalence of MRSA skin and/or soft tissue infection among HIV patients was found to be 4/271(1.5%). High proportion of MRSA SSTI was found among females 3/16(18.8%) than males 1/14(7.1%), however the difference in prevalence between the sexes was not statistically significant. (p=0.351) Prevalence of MRSA skin and/ or soft tissue infection was high among the patients CD4 counts <200, 3 (60.0%) compared to patients with CD4 count of 200-500cells/µL 1 (5.0%) patients p=0.003. None of the patients with CD4 cell count of >500 was found to have the MRSA. MRSA was found in the following lesions: folliculitis 1/1(100%), Ulcer 2/3 (66.7%) and abscess 1/5 (20%). MRSA skin and/or soft tissue infection was more common among patients who were on co-trimoxazole; 4/8 (50.0%) than on those who were not on co-trimoxazole prophylaxis 0/22 (0.0) % p=0.003 MRSA SSTI was significantly more prevalent 3/7 (42.9%) among patients with a prior history of using antibiotics compared to patient with no prior history of using antibiotics 1/23 (4.3%), p=0.009. The duration of antibiotic use was not found to have any significant relationship with MRSA skin and/or soft tissue infection. Hospital admission prior recruitment to the study was significantly found to be associated with MRSA. Among HIV patients with MRSA SSTI who had prior history of hospital admission; 2/4(50.0%) subjects had MRSA SSTI while only 2/26 (7.7%) patients with no prior history of hospital admission had MRSA. P = 0.020 Conclusion and Recommendation: MRSA in skin and/or soft tissue infection among HIV-infected patients is common and occurs mostly in HIV patients with low CD4 count, prior hospital admission, prior use of cotrimoxazole and other antibiotics. Early detection of patients with skin and/or soft tissue infection, prompt evaluation and proper treatment will minimize duration and transmission of infection. Preventive measures should be brought on including screening of the carriers, improving of personal hygiene, isolation of the potential infected patients to avoid spreading of the resistant strain of MRSA.