Community-associated methicillin-resistant staphylococcus aureus among gay, bisexual and other men who have sex with men living with human immunodeficiency virus engaged in chemsex: implications for prevention and rational antibiotic use
1
Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
2
Infectious Diseases Service, HIV Unit, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
3
Campus Clínic, Faculty of Medicine, University of Barcelona, Barcelona, Spain
4
Department of Clinical Microbiology, ISGlobal, Hospital Clínic-University of Barcelona, CIBERINFEC, Barcelona, Spain
5
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
6
Department of Migrant Health, Global Tuberculosis Program, Baylor College of Medicine, Houston, United States
7
HIV Unit, Infectious Disease Division, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
8
Infectious Diseases Service, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Community-associated methicillin-resistant staphylococcus aureus (CA-MRSA) infections are increasingly reported among gay, bisexual and other men who have sex with men (GBMSM) engaging in chemsex, yet data remain limited. This ambispective cohort study among people living with HIV (PLHIV) engaging in chemsex provides an assessment of clinical and microbiological characteristics, incidence and reinfections, as well as decolonization strategies, patterns of substance use, and sexual behaviours, and explores public health implications.
METHODS:
Epidemiological, behavioral, and clinical data were collected between 2018 and 2024 retrospectively from medical records and prospectively through standardized questionnaires. MRSA isolates from clinically indicated samples were identified by mass spectrometry and underwent antimicrobial susceptibility testing.
RESULTS:
Among 446 PLHIV, 62 (14%) were diagnosed with CA-MRSA, accounting for 109 episodes over a median follow-up of 3.21 years (interquartile range 1.39-5.05). Detectable HIV viral load occurred in 28% of episodes. GHB/GBL (92%) and methamphetamine (84%) were the most frequently reported substances. Polydrug use was reported by 95% of participants and 56% reported injection drug use (slamming). All episodes involved skin and soft-tissue infections, 17% required hospitalization and 35% surgical intervention. Non-active empirical antibiotics were prescribed in 51% of episodes. Recurrent infections occurred in 37% of participants. Resistance to clindamycin and cotrimoxazole was observed in 33% and 15% of isolates, respectively, and mupirocin resistance was high (96%). Decolonization was attempted in 65% of participants with available data.
CONCLUSIONS:
CA-MRSA infections were frequent and recurrent among GBMSM living with HIV engaging in chemsex. Substantial resistance and frequent use of non-active empirical antibiotics highlight gaps in prevention and rational antibiotic use. Early clinical suspicion and microbiological confirmation are essential for appropriate management. Given persistent high-risk behaviours, single decolonization regimens may be insufficient, and evidence-based preventive strategies, including repeated or prolonged decolonization, should be considered to improve quality of care and public health outcomes.
Community-associated methicillin-resistant staphylococcus aureus (CA-MRSA) infections are increasingly reported among gay, bisexual and other men who have sex with men (GBMSM) engaging in chemsex, yet data remain limited. This ambispective cohort study among people living with HIV (PLHIV) engaging in chemsex provides an assessment of clinical and microbiological characteristics, incidence and reinfections, as well as decolonization strategies, patterns of substance use, and sexual behaviours, and explores public health implications.
METHODS:
Epidemiological, behavioral, and clinical data were collected between 2018 and 2024 retrospectively from medical records and prospectively through standardized questionnaires. MRSA isolates from clinically indicated samples were identified by mass spectrometry and underwent antimicrobial susceptibility testing.
RESULTS:
Among 446 PLHIV, 62 (14%) were diagnosed with CA-MRSA, accounting for 109 episodes over a median follow-up of 3.21 years (interquartile range 1.39-5.05). Detectable HIV viral load occurred in 28% of episodes. GHB/GBL (92%) and methamphetamine (84%) were the most frequently reported substances. Polydrug use was reported by 95% of participants and 56% reported injection drug use (slamming). All episodes involved skin and soft-tissue infections, 17% required hospitalization and 35% surgical intervention. Non-active empirical antibiotics were prescribed in 51% of episodes. Recurrent infections occurred in 37% of participants. Resistance to clindamycin and cotrimoxazole was observed in 33% and 15% of isolates, respectively, and mupirocin resistance was high (96%). Decolonization was attempted in 65% of participants with available data.
CONCLUSIONS:
CA-MRSA infections were frequent and recurrent among GBMSM living with HIV engaging in chemsex. Substantial resistance and frequent use of non-active empirical antibiotics highlight gaps in prevention and rational antibiotic use. Early clinical suspicion and microbiological confirmation are essential for appropriate management. Given persistent high-risk behaviours, single decolonization regimens may be insufficient, and evidence-based preventive strategies, including repeated or prolonged decolonization, should be considered to improve quality of care and public health outcomes.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
