934. Incidence of Skin and Soft Tissue Infection in People Living with HIV in a Large Urban Public Health Care System in Houston, Texas, 2009-2014
Session: Oral Abstract Session: HIV-Related Comorbidities and Complications
Friday, October 5, 2018: 9:00 AM
Room: S 157

Background: Skin and soft tissue infections (SSTIs) disproportionately impact patients with HIV.  Recent declines have been noted in the incidence of SSTIs in the non-HIV population.  We set out to study the epidemiology and microbiology of SSTIs in a population of 8597 patients followed for HIV primary care in a large urban county system from 1/1/2009 to 12/31/2014.

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: 2202 SSTIs were identified.  Of 503 (22.8%) cultured SSTIs, 332 (66.0%) included S. aureus as a pathogen, of which 287/332 (86.4%) featured S. aureus as the sole pathogen. Of S. aureus isolates with susceptibilities, 231/331 (69.8%) were methicillin resistant, and the proportion did not vary by year (p=NS).

The observed incidence of SSTI was 78.0 per 1000 person-years (95% CI 72.9-83.4) and declined from 96.0 infections per 1000 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 CD4 count, viral load, and being a Spanish-speaking Hispanic.

Conclusion: Although SSTI rates in a large urban HIV-infected outpatient cohort declined approximately 40% between 2009 and 2014, SSTIs remain a significant problem.

Figure 1. SSTI incidence per 1000 Person-Years, 2009-2014

Table 1. Univariate and multivariate Poisson regression results

Factor

Univariate IRR

(95% CI)

Multivariate IRR

(95% CI)

Male gender

1.06 (0.92-1.22)

-

MSM

1.09 (0.95-1.25)

-

Race/ethnicity

White/Asian/other

Ref

Ref

Non-Hispanic African-American

0.92 (0.76-1.11)

0.86 (0.71-1.04)

English-speaking Hispanic

0.88 (0.69-1.12)

0.88 (0.69-1.12)

Spanish-speaking Hispanic

0.46¥ (0.36-0.60)

0.48¥ (0.37-0.62)

CD4 count (cells/µL)

100+

Ref

Ref

50-100

1.56* (1.19-2.04)

1.23 (0.93-1.62)

<50

2.28¥ (1.80-2.90)

1.49* (1.16-1.92)

Viral load (copies/mL)

<1000

Ref

Ref

1000+

2.17¥ (1.91-2.46)

1.90¥ (1.66-2.19)

Year

2009

Ref

Ref

2010

0.89 (0.75-1.06)

0.92 (0.78-1.10)

2011

0.90 (0.75-1.07)

0.96 (0.80-1.15)

2012

0.91 (0.76-1.09)

0.99 (0.83-1.19)

2013

0.71¥ (0.58-0.85)

0.77* (0.64-0.93)

2014

0.59¥ (0.49-0.71)

0.65¥ (0.54-0.79)

*p<0.01

¥p<0.001

Vagish Hemmige, MD, Division of Infectious Diseases, Montefiore Medical Center, Bronx, NY, Cesar Arias, MD, PhD, FIDSA, Microbiology and Molecular Genetics, University of Texas McGovern Medical School, Houston, TX, Siavash Pasalar, PhD, HarrisHealth, Houston, TX and Thomas P. Giordano, M.D., M.P.H., FIDSA, Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX

Disclosures:

V. Hemmige, None

C. Arias, Merck & Co., Inc.: Grant Investigator , Research support . MeMed: Grant Investigator , Research support . Allergan: Grant Investigator , Research support .

S. Pasalar, None

T. P. Giordano, None

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