Health Services Research & Development

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Hemmige V, Arias CA, Pasalar S, Giordano TP. Skin and Soft Tissue Infection in People Living with HIV in a Large Urban Public Health Care System in Houston, TX, 2009-2014. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2019 Jun 15.
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Abstract: BACKGROUND: Skin and soft tissue infections (SSTIs) disproportionately impact patients with 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 8,597 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 (EMR) by use of ICD-9 billing codes.  Charts were reviewed to confirm the diagnosis of acute SSTI and abstract culture and susceptibility data.  We calculated yearly SSTI incidence using Poisson regression with clustering by patient. RESULTS: 2,202 SSTIs were 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 1,000 person-years (95% CI 72.9-83.4) and declined from 96.0 infections per 1,000 person-years in 2009 to 56.5 infections per 1000 person-years in 2014 (p<0.001). Other significant predictors of SSTI incidence in both univariate as well as multivariate analysis included low CD4 count, high viral load, and not being a Spanish-speaking Hispanic. CONCLUSIONS: SSTIs remain a significant problem in the outpatient HIV-infected population, although rates of SSTI appear to have declined approximately 40% between 2009 and 2014.