Multidrug-Resistant CA-MRSA Infections Among HIV+ Persons
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: An emerging problem affecting HIV-infected persons is community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) infections. CA-MRSA infections usually manifest as skin infections and require both antibiotic and surgical therapy. CA-MRSA infections lead to considerable morbidity, such as hospitalization and surgery, and occasionally death. The rate of CA-MRSA infection is high among HIV-infected persons, especially among HIV-infected men who have sex with men (MSM) and HIV-infected drug users. Most CA-MRSA infections are caused by a single clone of MRSA, called USA300. Of great concern is that new strain of the USA300 CA-MRSA, called the pUSA03 subclone has emerged in the community as a cause of skin infections. Data from our group demonstrated that there has been a rapid rise in pUSA03 MRSA subclone infections and that this subclone almost exclusively infects HIV-infected persons and MSM. The pUSA03 subclone is resistant to almost all oral antibiotics used to treat skin and MRSA infections which makes treatment of these serious infections extremely challenging. There is an urgent need to describe and investigate the spread of this clone among HIV-infected persons, especially in California, where this subclone was first described. We will perform investigations relating to the spread of CA-MRSA and the pUSA03 MRSA subclone among HIV-infected persons. We will do this study in conjunction with California Collaborative Treatment Group (CCTG) Study 587, which will be conducted at 5 clinical sites in California. CCTG 587 is a prospective study of patients with and without acute CA-MRSA infection. Its aim is to examine the specific high-risk sexual and drug use behaviors that put persons at risk for this serious infection. The present application will add special molecular tests of the infecting MRSA and S. aureus strains isolated from case-patients in CCTG 587. Special emphasis will be made to identify the pUSA03 MRSA subclone, and describe how common a pathogen it is. Other studies will examine risks for this pUSA03 subclone and how often it lives on the body but doesn’t cause infections in persons who have no symptoms of a skin infection. Findings from our investigation will be critical for quantifying the rise of the highly concerning pUSA03 MRSA subclone in California. Our investigation will provide crucial information for physicians that are choosing antibiotic therapy for skin infections. Furthermore, our studies of body colonization and risk factors for the pUSA03 MRSA subclone will provide important insights why HIV-infected persons get CA-MRSA infection. Our findings will provide crucial information for the development future interventions to prevent spread and recurrence of this serious and common infection. Only by studying this disease in further detail can we begin to move forward to prevent HIV-infected persons from further suffering from the scourge of CA-MRSA infection.