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Brief Communication

Staphylococcus aureus Colonisation in HIV‑Infected Patients:

Incidence, Risk Factors and Subsequent Skin‑ and Soft‑Tissue
Infections
Aashirwad Panigrahy, Sanjeev Sinha1, Bimal Kumar Das, Arti Kapil, Sreenivas Vishnubhatla2, Benu Dhawan
Departments of Microbiology, 1Medicine and 2Biostatistics, All India Institute of Medical Sciences, New Delhi, India

Abstract
We evaluated the incidence and risk factors of Staphylococcus aureus colonisation in 300 treatment‑naïve HIV patients. Swabs from anterior
nares and pharynx were cultured. Eighty‑eight patients (29.3%) were colonised with S. aureus (47.7% nasal, 23.8% pharyngeal and 28.5% at
both sites), which yielded 112 isolates. Methicillin‑resistant S. aureus was detected in 25.9% (29/112) of isolates. Panton–Valentine leucocidin
gene was present in 18.8% (21/112) of isolates. Multiple logistic regression analysis identified CD4 count <200 cells/mm3, public bath use,
alcohol intake and other sexually transmitted infections as independent predictors for S. aureus colonisation. On follow‑up, 22.7% of patients
with S. aureus colonisation developed skin‑ and soft‑tissue infections. Strategies for behavioural changes would be helpful in controlling
S. aureus colonisation and subsequent infection.

Keywords: HIV patients, methicillin‑resistant Staphylococcus aureus, Panton–Valentine leucocidin, skin‑ and soft‑tissue infection,
Staphylococcus aureus

Introduction Materials and Methods

Staphylococcus aureus is a commensal on human skin, with
anterior nares being the most common site of colonisation.
Being immunocompromised, HIV‑positive patients present
with higher colonisation as compared to a healthy population.[1,2]
Panton–Valentine leucocidin (PVL) helps in the colonisation,
invasion and evasion of the immune system by S. aureus. It is
a pore‑forming toxin causing neutrophil lysis and apoptosis
and contributes to tissue necrosis.[3]
S. aureus contributes to 65% of all skin‑ and soft‑tissue
infection (SSTI) cases in HIV‑infected population. [4] The
risk of SSTIs increases with previous colonisation of S.
aureus. [5] However, despite highly active antiretroviral
therapy  (HAART) introduction, the incidence of S.
aureus infections continues to remain high. [6] Therefore,
additional information is required to define incidence
rates and also to ascertain immunological and behavioural
factors associated with staphylococcal colonisation in
HIV‑infected patients.
This prospective study was conducted from February 2018 to
October 2019. Patients attending the Integrated Counselling
and Testing Centre of AIIMS, New  Delhi, were enrolled if
they fulfilled the following inclusion criteria: treatment‑naïve
HIV‑positive patients  >18  years of age, whereas patients
on antitubercular therapy and topical mupirocin use in
anterior nares in the last 2  weeks were excluded from the
study. Sociodemographic, clinical and behavioural data
were collected through individual interviews in a structured
pro forma. This study was approved by the institute’s ethics
committee (IECPG‑699/31.01.2018).
Address for correspondence: Dr. Benu Dhawan,
Department of Microbiology, All India Institute of Medical Sciences,
New Delhi ‑ 110 029, India.
E‑mail: dhawanb@gmail.com
Received: 03‑01‑2020 Revised: 31‑07‑2020
 Accepted: 06-08-2020 Published Online: 04-11-2020

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How to cite this article: Panigrahy A, Sinha S, Das BK, Kapil A,

DOI: Vishnubhatla S, Dhawan B. Staphylococcus aureus colonisation in HIV-
10.4103/ijmm.IJMM_20_5 infected patients: Incidence, risk factors and subsequent skin- and soft-tissue
infections. Indian J Med Microbiol 2020;38:444-7.

444 © 2020 Indian Journal of Medical Microbiology | Published by Wolters Kluwer - Medknow
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Indian Journal of Medical Microbiology, 38 (2020) 444-447. doi:10.4103/ijmm.IJMM_20_5

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Indian Journal of Medical Microbiology, 38 (2020) 444-447. doi:10.4103/ijmm.IJMM_20_5

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Indian Journal of Medical Microbiology, 38 (2020) 444-447. doi:10.4103/ijmm.IJMM_20_5