However, one study in
HIV-infected patients found that isolate sensitivity to empirical antibiotics was associated with clinical resolution after controlling for drainage procedures [27]. Several studies have reported the use Obeticholic Acid of combination antibiotics among HIV-infected patients [22, 24, 26, 29, 33, 34]. In a case series of HIV-infected men with SSTIs, it was noted that 83% were treated with combination regimens consisting of TMP-SMX/rifampin, TMP-SMX/doxycycline, or doxycycline/rifampin [30]; nevertheless, it is currently unknown whether combination therapy is more effective than single antibiotic treatment. Most HIV-infected persons with MRSA SSTIs recover without complications,
and mortality rates have been low [5, 22, 37]. Regarding invasive MRSA infections among HIV-infected patients, two early studies reported mortality rates of 22–34% [6, 23]; however, it is currently unknown whether mortality rates for these infections remain high. Whether HIV-infected patients have a higher mortality rate compared with HIV-uninfected persons is also unclear, but outcome is probably related to the Lapatinib supplier presence of underlying conditions and the level of immunosuppression [6, 23]. Studies in the general population and among HIV-infected patients have shown that MRSA bacteraemia is associated with increased length of hospitalization and mortality rates compared with methicillin-sensitive Staphylococcus aureus (MSSA) bacteraemia [23, 65]. Similarly, USA300 strains causing bacteraemia
may be associated with higher mortality rates [53]. Table 5 lists potential strategies for preventing MRSA infections [66]. Areas for additional research include the impact of avoiding high-risk sexual practices on reducing MRSA infections [32]. Regarding decolonization of MRSA carriage, only one study among HIV-infected persons in the HAART era was noted in our literature review – a study at a drug rehabilitation facility which found that mupirocin reduced the odds of S. aureus nasal colonization by 83% compared with placebo (P < 0.001); however, it found no significant difference in infection selleck products rates (hazard ratio 0.49; P = 0.29) [67]. Future studies on decolonization strategies among HIV-infected patients should be considered and include decolonization strategies aimed at additional body sites, including the perigenital regions [10]. Finally, HAART use and improved immunological status may be associated with a reduced incidence of MRSA infections [5, 20, 25, 31, 35, 38]; however, further research is needed. Recommended strategies CDC MRSA Prevention Guidelines* Practicing good hygiene Avoiding sharing of personal items (e.g.