Skin and soft tissue infections (SSTIs) are common in the
era of community-associated methicillin resistant Staphylococcus aureus among HIV-infected patients. Recurrent infections
are frequent. Risk factors for recurrence after an initial SSTI have not been
well-studied.
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. The 1-year
Kaplan-Meier estimated risk of a second SSTI was 29.2 %, while the 3-year risk was 47.0 %. Risk factors for recurrent SSTI in a multivariable Cox
regression model were non-hepatitis liver disease, the presence of an
intravenous catheter,
and a history of intravenous drug use (IVDU);
African-American race was associated with decreased risk of recurrent SSTI. Some evidence was present
for HIV viral load ≥ 1000
copies/mL as an independent risk factor for recurrent SSTI.
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.
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.
Below: Kaplan-Meier curve demonstrating the cumulative risk of recurrent SSTI over time with 95 % confidence intervals
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at:
1Division of Infectious Diseases, Department
of Medicine, Baylor College of Medicine, 6620 Main, Suite 1375, Houston 77030,
TX, USA
2Department of Medicine, University of
Chicago, 5841 S Maryland, Chicago 60637, IL, USA
3Department of Pediatrics and Department of
Public Health Sciences, University of Chicago, 5841 S. Maryland Ave. MC6054,
Chicago 60637, IL, USA
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