HIV Clinical Management

Journal of the International

Association of Providers of AIDS Care
Incidence and Risk Factors of Nasal 2016, Vol. 15(2) 141–147
ª The Author(s) 2014
Reprints and permission:
Carriage of Staphylococcus aureus in sagepub.com/journalsPermissions.nav
DOI: 10.1177/2325957414554005
HIV-Infected Individuals in Comparison jiapac.sagepub.com

to HIV-Uninfected Individuals:
A Case–Control Study

Ruchi Kotpal, MD1, Krishna Prakash S., MD2, Preena Bhalla, MD2,
Richa Dewan, MD3, and Ravinder Kaur, MD2

Abstract
The study was conducted to evaluate the prevalence of nasal colonization of Staphylococcus aureus in individuals with HIV infection
attending the Integrated Counselling and Testing Centre in a teaching hospital and compare the prevalence with HIV-uninfected
individuals. A case–control study was conducted among newly diagnosed HIV-infected individuals and an equal number of age-
group and sex-matched HIV-uninfected individuals, and nasal swabs were collected from both the samples. Sociodemographic
and clinical data were collected through individual interviews. Ethical aspects were respected. A total of 100 individuals partici-
pated in the study, and 22 (44%) of the 50 HIV-infected cases were colonized by S aureus, including 19 (86.4%) methicillin-sensitive
S aureus (MSSA) and 3 (13.6%) methicillin-resistant S aureus (MRSA). Only 12 (24%) strains were isolated from 50 HIV-uninfected
individuals, with 11 being MSSA and 1 being MRSA. This difference in the isolation rate was statistically significant (P ¼ .035). The 2
most commonly encountered risk factors in both the groups appeared to be history of tuberculosis and history of surgical pro-
cedures but none being statistically significant (P ¼ .093 and P ¼ .996). All the strains of S aureus were sensitive to mupirocin. The
study concluded that HIV-infected individuals are at a higher risk of carriage as compared to HIV-uninfected individuals. By elim-
inating carriage in immunocompromised individuals, infections due to S aureus can also be minimized.

Keywords
Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, HIV infected, HIV uninfected, nasal carriage

Introduction difficult. It is in this context that we now view methicillin-

The relationship between colonization with Staphylococcus
aureus and HIV infection is of particular interest due to the
morbidity and mortality associated with staphylococcal infec-
tions in HIV-infected patients.1 Despite multiple reports on the
severity and recurrent nature of S aureus infection,2 the factors
predisposing HIV-infected patients to S aureus infection do not
appear to have been well studied.
The growing number of patients infected with HIV warrants
more studies to establish the importance of nasal carriage for
the development of infection. Furthermore, the underlying
mechanism of increased carriage in this group of patients
remains to be elucidated. It has been pointed out that defining
the risk factors for S aureus infection in patients with HIV
infection is needed so that high-risk patients who may benefit
from preventive strategies can be identified.3
Staphylococcus aureus is one of the most versatile human
pathogens and is notoriously virulent. It has the ability to
acquire antimicrobial resistance easily, making treatment
resistant S aureus (MRSA) as a worldwide phenomenon.4
Methicillin-resistant S aureus was first reported in 1960s, and
it started to establish itself as a nosocomial pathogen with
increasing prevalence rates among hospitals nationally and
worldwide.5,6 Originally associated with health care acquired
infections, MRSA began to be recognized as an important
1
Department of Microbiology, Microbiology at Super Religare Laboratories,
Meerut, Uttar Pradesh, India
2
Department of Microbiology, Maulana Azad Medical College, New Delhi,
Delhi, India
3
Department of Medicine, Associated Lok Nayak Hospital, New Delhi, Delhi,
India
Corresponding Author:
Ruchi Kotpal, Department of Microbiology, Microbiology at Super Religare
Laboratories, R-7, Jawahar Quarters (47 Civil Lines), Begum Bridge, Meerut,
Uttar Pradesh 250001, India.
Email: drruchikotpal@gmail.com
142 Journal of the International Association of Providers of AIDS Care 15(2)
cause of community acquired infections in late 1990s.7
Methicillin-resistant S aureus has thus established itself as a
heterogenous group of organisms with different epidemic
potentials resulting in its constantly evolving epidemiology.
HIV-infected patients are now recognized as one of these
higher risk groups due to the increased rates of both MRSA
colonization and infections over the past decade. The organ-
ism’s interactions and disease manifestations in the immuno-
compromised host are expected to be complex and diverse as
the epidemiology of MRSA and HIV continues to change over
time.
We report the incidence of nasal carriage of S aureus and
MRSA among the HIV-infected and HIV-uninfected individu-
als in the community and elicit various risk factors that would
lead to increased carriage in these high-risk patients. Also by
eliminating the carriage in these groups, we can decrease the
incidence of staphylococcal infections anywhere in the body.
Study Design
The present study is a case–control study enrolling 50 newly
diagnosed HIV-infected individuals and an equal number of
age-group and sex-matched HIV-uninfected individuals attend-
ing the Integrated Counselling and Testing Centre of a tertiary
hospital during the period of January to December 2010. This
research project was considered and approved by the research
ethics committee of the hospital.
The inclusion criteria established included individuals
between 20 to 50 years of age and those with laboratory
confirmed HIV positivity. Those excluded from the study
were younger than 20 years and older than 50 years of age,
patients clinically suspected to have active tuberculosis, those
on antiretroviral therapy, and who had a history of
application of topical mupirocin in the anterior nares in the
last 2 weeks.
Study Procedures
Those who participated in the study received information refer-
ring to the study objectives and the research’s ethical aspects;
and once the individual had understood and accepted to partic-
ipate, he or she signed the informed consent. Sociodemo-
graphic, clinical, and behavioral data were collected through
individual interviews in a structured proforma. The nasal secre-
tion was obtained using self-made cotton swabs, these being
rubbed lightly in the left and right anterior nares of every study
participant. All aseptic precautions were observed while collect-
ing the specimens and were immediately transported to the
department of microbiology and processed.
Laboratory Identification and Antimicrobial Susceptibility
One of the swabs collected from the nares was inoculated in
a selective mannitol salt broth, and the other was inoculated
onto 5% sheep blood agar and MacConkey’s agar as well. The
plates and the broth were incubated aerobically at 37 C. After
overnight incubation, the plates were read. Subcultures were
made from the mannitol salt broth onto 5% sheep blood agar
and MacConkey’s medium and incubated again at 37 C and
read the following day. Hemolytic 1-mm colony on blood agar
was confirmed as S aureus by tube coagulase and anaerobic
mannitol test. All the isolated strains of S aureus were also
tested for methicillin resistance by the cefoxitin disc method
as recommended by Clinical Laboratory Standards Institute.8
Cefoxitin-resistant S aureus were confirmed as MRSA by
VITEK 2 system (BioMerieux Inc, France). Further antimicro-
bial susceptibility pattern of all the strains of S aureus including
MRSA was determined using the disc diffusion method by
employing the modified Stokes technique10 as follows: penicil-
lin (10 IU), cephalexin, cefazolin, clindamycin (2 mg), erythro-
mycin (15 mg), ofloxacin (5 mg), ciprofloxacin (5 mg), amikacin
(30 mg), gentamicin (10 mg), netilmicin (30 mg), tobramycin (10
mg), framycetin (100 mg), isepamycin (30 mg), fusidic acid (10
mg), chloramphenicol (5 mg), rifampicin (5 mg), cotrimoxazole
(1.25/23.75 mg), tetracycline (30 mg), vancomycin (30 mg), tei-
coplanin (30 mg), and linezolid (30 mg).
The minimum inhibitory concentrations (MICs) of mupiro-
cin, for all isolates of S aureus, were determined by the E-test
(AB-Biodisk Solna, Sweden). Standard control strains of S aur-
eus NCTC 6571 was used as the reference strain.
Phage Typing
All the strains of S aureus were phage typed by using the conven-
tional set of phages as described by Blair and Williams.9 Phage
typing was done at the National Phage Typing Centre, Maulana
Azad Medical College, New Delhi, India. The propagating strain
was first subcultured onto a blood agar plate. A single colony was
picked up, and the phage pattern was checked using the 23 phages
of the basic set at 1 and 100 routine test dilution (RTD). Strains
that were nontypable at 1 RTD were typed at 100 RTD.
Phage typing using supplementary MRSA phages. All MRSA
strains were additionally phage typed using 9 supplementary
phages. The 9 phages used were M3, M5, M12, M8, MR25,
622, C30, C33, and C38.
Statistical Analysis
The data were organized in Microsoft Office and Mac Excel
2011 spreadsheets and then exported to the Statistical Package
for the Social Science program, version 17.0. All the qualitative
data were compared using the chi-square test or the Fisher
exact test. On the other hand, all quantitative data were com-
pared using t test or nonparametric Mann-Whitney test.
Result
A total of 100 individuals (50 HIV infected and 50 HIV
uninfected) participated in the study. The mean age of the
HIV-unfected group was 33.96 + 8.471 (50, 18) and of the
HIV-uninfected group was 33.78 + 7.965. (48, 20) In both the
Kotpal et al 143

Table 1. Total Cases with Various Risk Factors in HIV-Infected and HIV-Uninfected Individuals.

Number of HIV-Infected Individuals with Number of HIV-Uninfected Individuals with

Various Risk Factors, N ¼ 50 (%) Various Risk Factors, N ¼ 50 (%)

Risk Factors n % n %

Hospitalization in the last 6 months 11 22 4 8

Intake of antibiotics in the last 3 months 7 14 3 6
Present intake of antibiotics 9 18 4 8
History of surgical procedure 18 36 9 18
History of tuberculosis 16 32 7 14
History of diabetes 1 2 0 0
History of alcohol intake 12 24 9 18
History of IVD 1 2 0 0
History of malignancy 0 0 0 0
History of smoking 6 12 5 10
History of corticosteroid intake 0 0 2 4
History of candidiasis 6 12 1 2
History of dermatitis 3 6 3 6
History of STI 3 6 3 6
History of MSM 4 8 0 0
Abbreviations: IVD, intravenous drug; STI, sexually transmitted infection; MSM, men having sex with men.

groups, 18 (36%) participants were female, 31 (62%) were Table 2. Isolation Rates of MRSA and MSSA Obtained from Nasal
male, and a single (2%) transgender. In relation to education, Swabs in HIV-Infected and HIV-uninfected Individuals.
20% of the interviewers were illiterate, 26% had completed pri-
HIV Positive HIV Negative Total
mary school, 38% had completed high school, 12% completed
twelfth standard, and 4% were graduate. In all, 90% of the n % n % n %
study participants were married, of which 80% were living with
MRSA 3 13.6 1 8.3 4 11.8
their spouses.
MSSA 19 86.4 11 91.7 30 88.2
Of the 50 HIV-infected cases, 47 (94%) acquired HIV Total 22 100 12 100 34 100
infection by sexual route, 7 (14%) gave a history of blood
transfusion, and only 1 (2%) was intravenous drug (IVD) abu- Abbreviations: MRSA, methicillin-resistant Staphylococcus aureus; MSSA,
methicillin-sensitive S aureus.
ser. None of the cases were acquired by vertical transmission.
Of the 50 HIV-infected individuals enrolled in the study,
11 (22%) reported hospitalization in the past, 18 (36%) gave History of tuberculosis (45.45%), history of surgical pro-
a history of surgical procedure, 16 (32%) had a history of cedures (40.90%), and history of hospitalization (27.27%)
tuberculosis, 12 (24%) were alcoholic, 6 (12%) were smokers, were the most common risk factors associated with nasal
and 7 (14%) had taken antibiotics in the last 3 months. Also, colonization in both the groups, but none of the risk factors
few (9) were taking antibiotics at the time of sampling, 1 was studied was statistically significant. Other risk factors asso-
diabetic, 3 had dermatitis, and 3 had a history of sexually ciated with carriage were intake of antibiotics in the last
transmitted disease (Table 1). Of the study participants, 4 3 months (18.18%), history of alcohol intake (13.63%),
(8%) were men having sex with men (MSM). The mean smoking (9.09%), history of dermatitis (9.09%), and MSM
CD4 count of the HIV-infected cases was 231 + 192.126 (9.09%). History of mucocutaneous candidiasis (4.54%),
(926, 12). Seventy-six percent of the patients had a CD4 count sexually transmitted disease (4.54%), and intravenous drug
of less than cells/mm3. abuse (4.54%) are also associated with carriage (Table 3).
The microbial analysis of the material resulted in 44% (22 With regard to the type of sexual behavior in the HIV-
cases) of HIV-infected individuals colonized with S aureus infected cases from whom nasal swabs grew S aureus, it
as compared to 24% (12 cases) of the HIV-uninfected individu- was found that 18 (90%) individuals were practicing hetero-
als. This difference in the isolation rate of S aureus in both the sexual activity, and 1 isolate each were reported from indi-
groups was statistically significant (P ¼ .035). Among those viduals practicing homosexual and bisexual activity (Table
who were colonized in the HIV-infected group, 86.4% (19 cases) 4 and B).
were sensitive to cefoxitin and are known as methicillin- In relation to the HIV viral load, S aureus was isolated from
sensitive S aureus (MSSA) and 3 (13.6%) were resistant 50% of the cases with a CD4 count <200 cells/mm3, while
to cefoxitin, known as MRSA. In the HIV-noninfected 22.7% of the cases had a CD4 count >350 cells/mm3.
group, only 1 (8.7%) was cefoxitin resistant, that is, MRSA Methicillin-resistant S aureus was identified in 3 (6%) individ-
(Table 2). uals with a CD4 count < 200 cells/mm3 (Table 5).
144 Journal of the International Association of Providers of AIDS Care 15(2)

Table 3. Comparison of Risk Factors for Nasal Carriage of Staphylococcus aureus in HIV-Infected and HIV-Unoninfected Individuals.

Number of HIV-Infected Individuals from Number of HIV-Uninfected Individuals from

Whom S aureus Was Isolated from Nasal Whom S aureus Was Isolated from Nasal
Swab, n ¼ 22 (%) Swab, n ¼ 12 (%)

Risk Factors n % n % P Value

Hospitalization in the last 6 months 6 27.27 1 8.33 .378

Intake of antibiotics in the last 3 months 4 18.18 1 8.33 .635
Present intake of antibiotics 2 9.09 0 0 .529
History of surgical procedure 9 40.90 5 41.7 .966
History of tuberculosis 10 45.45 2 16.66 .093
History of diabetes 1 4.54 0 0 1.000
History of alcohol intake 3 13.63 2 16.66 1.000
History of IVD 1 4.54 0 0 1.000
History of malignancy 0 0 0 0 –
History of smoking 2 9.09 2 16.33 .602
History of corticosteroid intake 0 0 0 –
History of candidiasis 1 4.54 0 0 1.000
History of dermatitis 2 9.09 0 0 .529
History of STI 1 4.54 1 8.33 1.000
History of MSM 2 9.09 0 0 .529
Abbreviations: IVD, intravenous drug; STI, sexually transmitted infection; MSM, men having sex with men.

Table 4A. Risk Factors for HIV Transmission Seen in HIV-Infected Table 5. CD4 Count of the Study Participants with MSSA and MRSA
Cases in Whom Staphylococcus aureus Was Isolated from Nasal Swab.a from Nasal Swabs.

Total CD4 Cases with MSSA Cases with MRSA Total Number of
Count, from Nasal from Nasal Cases with
Risk Factor Males Females Transgender n % cells/mL Swabs, n ¼ 19 Swabs, n ¼ 3 MSSA and MRSA
Sexual 10 9 1 20 91.0 <350 14 3 17
Blood transfusion 0 1 0 1 4.5 >350 5 0 5
IVD 1 0 0 1 4.5 Total 19 3 22
Mother-to-child transmis- 0 0 0 0 0
sion prick injury Abbreviations: MSSA, methicillin-sensitive Staphylococcus aureus; MRSA,
Needle prick injury 0 0 0 0 0 methicillin-resistant S aureus.
Total 11 10 1 22 100
.260), and history of mucocutaneous candidiasis (33.33%,
Abbreviation: IVD, intravenous drug.
a
n ¼ 22. P ¼ .136) comprised the various risk factors. All 3 individ-
uals whose nasal swabs yielded MRSA had a CD4 count
<200 cell/mm3 (P ¼ 1.000).
Table 4B. Type of sexual behavior in the HIV infected cases whose
nasal swabs grew Staphylococcus aureus.

From Nasal Swabs

Risk Factors for Nasal Carriage of MSSA
in HIV-Infected Individuals
Type of Sexual Behavior n %
MSSA colonization was reported in 36.36% males. Four had a
Heterosexual 18 90.0 history of hospitalization in the last 6 months and 2 had a history
Homosexual 1 5.0 of intake of antibiotics. History of surgical procedures, tubercu-
Bisexual 1 5.0 losis in the past, diabetes mellitus, alcohol intake, smoking, and
Total 20 100
dermatitis were the various risk factors for MSSA colonization.

Risk Factors for Nasal Carriage of MRSA Antibiotic Susceptibility Pattern

in HIV-Infected Individuals
All the 3 cases with MRSA carriage in nares were males.
History of surgical procedure (33.33%, P ¼ 1.000), tuberculo-
sis in the past (66.66%, P ¼ .571), alcohol intake (66.66%,
P ¼ .038), IVD (33.33%, P ¼ .136), smoking (33.33%, P ¼
The antibiotic resistance pattern of S aureus isolated from the
nasal swabs of HIV-infected cases was different from those of
HIV-uninfected cases. All the isolates of S aureus from both the
groups were resistant to penicillin. A high percentage of strains
from the HIV-infected cases showed resistance to erythromycin
Kotpal et al 145

The 4 strains that were typable showed 2 different typing pat-

120
Percentage Resistance of Staphylococcus aureus terns, either 622 or 622/C22 phage type.
100

80 Discussion
60 As demonstrated in our study, nasal colonization of S aureus
40 in the HIV-infected group is more than that in the HIV-
uninfected group, wherein nasal swabs from HIV-infected
20
cases yielded a higher carriage rate of 44% as compared to
0 HIV-uninfected group (24%). Many published studies among
Erythromycin

Fusidic acid
Anbioc

Rifampicin
Penicillin
Cephalexin
Cefazolin
Clindamycin

Ofloxacin
Ciprofloxacin
Amikacin
Gentamicin
Nelmicin
Tobramycin
Framycen
Isepamycin
Mupirocin

Chloramphenicol

Cotrimoxazole
Tetracycline
Vancomycin
Teicoplanin
In HIV infected In HIV noninfected
Figure 1. Comparison of resistance of Staphylococcus aureus isolates
from the nasal swabs of HIV-infected and HIV-uninfected cases.
(27.3%), ofloxacin (45.5%), ciprofloxacin (59.1%), and cotri-
moxazole (77.3%). Strains from HIV-uninfected cases were also
resistant to the above-mentioned antibiotics, but the percentage
resistance found among these groups was much lower—erythro-
mycin (25.0%), ofloxacin (33.3%), ciprofloxacin (33.3%), and
cotrimoxazole (50.0%; Figure 1).
Since the number of MRSA isolates was so few, it would
be futile to attempt to draw any conclusion by comparing
the percentages of resistance seen in the MRSA strains iso-
lated from the HIV-infected versus those from the HIV-
uninfected cases.
The MIC for mupirocin for all the 34 isolates of S aureus
was determined by using the E-test. The MIC ranges, MIC50
and MIC90 values, of the isolates of S aureus (MSSA and
MRSA) for mupirocin were <0.064 mg/mL and <0.064 mg/mL,
respectively. Of the 34 strains tested from the nasal swab,
33 showed an MIC of <0.064 mg/mL, while a single MSSA
strain isolated from the nasal swab of an HIV-infected case
had an MIC of 4.0 mg/mL. All the 4 MRSA isolates from nares
showed an MIC of <0.064 mg/mL. All the nasal isolates of S
aureus were sensitive to mupirocin, hence facilitating nasal
carriage of this organism by its topical application. However,
all the strains irrespective of their methicillin status were
found to be sensitive to the 2 glycopeptides, namely, vanco-
mycin, teicoplanin, and linezolid.
Phage typing. While 90.9% of the isolates from HIV-infected
cases were typable, only 33.3% of isolates from HIV-
uninfected cases were typable. A high percentage (94.7%) of
the MSSA isolates from the nasal swabs of the HIV-infected
cases were typable, whereas only 36.4% of the MSSA isolated
from nasal swabs of HIV-uninfected cases were typable. Also,
the sole MRSA isolate from the uninfected cases was
nontypable.
All 4 MRSA when additionally typed using 9 supplementary
phages for MRSA were found to be typable (100% typability).
HIV-infected patients showed slightly lower carriage rate
than that reported in our study (ie, Nguyen et al3 [34%],
Villacian et al11 [23%], and McDonald et al12 [33%]). A sole
Indian study reported a much higher rate of isolation (76.67%).1
In the control group (ie, HIV-uninfected individuals), all the
studies13,15 showed almost similar carriage rate as that of ours,
but none of the studies have compared the carriage rate between
both the groups.
During 2010, methicillin-resistant S aureus accounted for
13.6% of all our S aureus isolates, which is identical to that
reported by McDonald et al.12 Methicillin-resistant S aureus
carriage rate among the HIV-infected group has been known
to be increasing every year. A study conducted in 200813 found
a carriage rate of 10.3%, as compared to a study in 200411
which reported an isolation rate as low as 3%. These data col-
lectively demonstrate the increasing trend of MRSA coloniza-
tion among these HIV-infected groups, without explaining the
exact reason for this increasing trend.
Various risk factors that predispose to the colonization
included a history of hospitalization in the last 6 months, those
with intake of antibiotics in last 3 months, those with history of
surgical procedures, and those with a history of tuberculosis
showed higher carriage rates of S aureus than their correspond-
ing HIV noninfected counterparts with a similar history. Nev-
ertheless, it may be mentioned that although these carriage
rates were more in the HIV-infected group, the difference did
not appear to be statistically significant. This comparison does
not appear to have been reported by any other worker. How-
ever, others have correlated the association of the risk factors
in those HIV-infected cases from whom S aureus (MSSA or
MRSA) was isolated. Chacko et al1 also made similar observa-
tions and reported that a higher carriage of S aureus was present
in those HIV-infected cases with previous history of hospitali-
zation and systemic infections like tuberculosis.
Of the 3 cases from whom MRSA was isolated, 2 had a
history of hospitalization and intake of antibiotics in the last
3 months. These findings are similar to those of Villacian
et al11 who observed that previous use of antibiotics and admis-
sion to the hospital during the preceding year are the risk fac-
tors for nasal colonization of MRSA. Likewise, 1 case with
MRSA colonization in the anterior nares gave a history of
mucocutaneous candidiasis, which was similar to the finding
of Chacko et al1 and McDonald et al.12
In our finding, 77.3% of our isolates had a CD4 count <350
cells/mL, and all MRSA isolated from those patients with CD4
count <200 cells/mL were consistent with previous studies.1,13
146 Journal of the International Association of Providers of AIDS Care 15(2)
McDonald et al12 observed 12.2% resistance to ofloxacin
and Chacko et al1 observed 41.3% to yet another fluoroquino-
lone ciprofloxacin, but the present study recorded that the rates
of resistance for these 2 agents were much higher at 45.5% and
59.1%, respectively. On the other hand, Chacko et al1 have
reported a resistance rate of 69.57% to cotrimoxazole, while
our resistance rate was much higher at 77.3%. We attribute
these increased rates of resistance to the wide spread and prob-
ably inappropriate use of fluroquinolones and cotrimoxazole in
clinical practice as well as a general trend of increased resis-
tance over the years. Surprisingly, only 13.6% of our isolates
were resistant to gentamicin, and this finding is somewhat sim-
ilar to the figure of 10.2% reported by McDonald et al.12 It was
demonstrated both in Chacko et al study1 and in our study that
all isolates are sensitive to vancomycin. Our isolates from HIV-
noninfected cases also showed much less resistance as com-
pared to their HIV-infected counterparts, hence much easily
treatable compared to HIV-infected isolates.
Eradication of S aureus carriage served 2 purposes, that
is, prevention of infection and prevention of transmission.14
Many techniques have been used to eradicate S aureus from
the nares, such as the use of systemic antimicrobials, normal
bacterial flora augmentation, antiseptic washes, and topical
antimicrobials. For a number of potential reasons, including
efficacy and minimization of systemic antibiotic use, topical
intranasal therapies have been recognized as a preferred
method.15
Mupirocin has emerged as the topical antibacterial agent
of choice for elimination of S aureus nasal carriage.16
Mupirocin produced by Pseudomonas fluorescens inhibits
bacterial protein synthesis by reversibly binding to bacterial
isoleucyl-tRNA synthetase.17 Significant potential exists for
mupirocin, as an agent to reduce nasal colonization and sub-
sequent systemic S aureus infection.18 So we determined the
sensitivity of mupirocin so that nasal carriage can be elim-
inated from these groups of immunocompromised patients.
We found that none of the strains of S aureus either from
HIV-infected or from HIV-uninfected cases appeared resis-
tant to mupirocin. Our results are significant, since in this
study the isolates were all from the anterior nares where
topical mupirocin is widely used.
To summarize, HIV-infected individuals are at an increase
risk of carriage of S aureus in particular MRSA as compared
to HIV-noninfected group. Risk factors for carriage included
lower CD4 count, hospitalization in the past, surgical interven-
tion in the past, and history of mucocutaneous candidiasis. All
the S aureus strains were sensitive to mupirocin as determined
by the MIC, so application of this drug topically can eliminate
carriage and subsequently infection anywhere in the body can
be eliminated.
Acknowledgments
We acknowledge with gratitude the technical assistance rendered by
Shri Ram Prasad and Smt Vijay Arora and also Mrs Prem Lata from
National Phage Typing Centre, Department of Microbiology, Maulana
Azad Medical College, New Delhi, India.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship,
and/or publication of this article.
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