Several studies have noted multiple recurrence events among HIV-infected persons [22, 26, 35], including one case with 24 distinct MRSA SSTIs [43]. SSTI recurrence rates as high as 71% have been observed in clinical cohort studies of HIV patients [33]. Furthermore, a study among IDUs admitted for an SSTI showed that HIV-positive status was associated with a 3-fold increase in readmission rates, largely Dabrafenib in vivo as a result of recurrent infections [56]. In addition to documented recurrent MRSA SSTIs, HIV-infected

patients may also develop recurrent SSTIs not specifically defined as MRSA [because of the lack of a culture (e.g. cellulitis) or negative results] [5, 10, 22, 29, 35]. Suppressed HIV RNA levels (<1000 HIV-1 RNA copies/ml) and higher CD4 counts (>200 cells/μL) appear to be potentially protective against recurrent infections [29,

35]. However, high recurrence rates have been observed even in patients with high CD4 counts (>400 cells/μL), suggesting that other factors are involved [5, 10, 35]. Further, recurrences may develop despite appropriate initial antibiotic therapy [22]. Behavioural factors (e.g. sexual and drug-using behaviours), this website increased MRSA colonization, and elevated hospitalization rates may partially explain the increased susceptibility to recurrence in HIV patients. Table 3 provides a review of the antibiotic resistance patterns of MRSA isolates among HIV-infected patients in published studies and focuses on patterns of CA-MRSA isolates [5, 20, 22, 24-27, 29, 32-34, 36, 37]. Resistance to TMP-SMX in MRSA isolates has been low, suggesting oxyclozanide that TMP-SMX is currently one of the most reliable oral antibiotics against CA-MRSA. Resistance to gentamicin or rifampin has been nearly absent among HIV-infected persons in the HAART era, and no studies have reported vancomycin resistance among MRSA isolates [9, 22, 24-26, 32]. Newer agents in the anti-MRSA armamentarium, including linezolid, have typically not been reported, but a single study of 183 isolates showed no resistance among HIV-infected patients [32]. The emergence

of a multi-drug-resistant MRSA strain has been noted – this novel USA300 MRSA strain contains a conjugative plasmid called pUSA03 carrying both ermC and mupA, leading to resistance to macrolides, clindamycin and mupirocin; this strain, additionally, is resistant to fluoroquinolones [32]. The dissemination of multi-drug-resistant strains among HIV-infected populations is of great concern, and may significantly limit both treatment and decolonization options. Acquisition of culture and antimicrobial susceptibility data is advocated for both patient management and epidemiological surveillance. Among HIV-infected persons, CA-MRSA SSTIs are predominantly caused by pulsed-field type USA300/multilocus sequence type 8 strains [4, 20, 30, 32, 33], similar to the general population [57, 58].