Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis.
BACKGROUND
Current evidence does not provide a clear definition of the association between methicillin-resistant Staphylococcus aureus (MRSA) isolation and previous antibiotic use. A systematic review was performed to determine whether antibiotic exposure is a risk factor for the isolation of MRSA.


METHODS
MEDLINE and EMBASE databases were searched to identify studies published between 1976 and 2007 on the role of antibiotics as a risk factor for MRSA isolation in adult patients. The outcome of interest was MRSA isolation. Summary statistics were risk ratios (RR) comparing MRSA-positive patients to those without S. aureus isolation or with methicillin-susceptible S. aureus isolation.


RESULTS
Seventy-six studies, including a total of 24 230 patients, met the inclusion criteria. Antibiotic exposure was determined in the 126 +/- 184 (mean +/- SD) days preceding MRSA isolation. The risk of acquiring MRSA was increased by 1.8-fold [95% confidence interval (CI), 1.7-1.9; P < 0.001] in patients who had taken antibiotics. The RR for single classes of antibiotics was 3 (95% CI, 2.5-3.5) for quinolones, 2.9 (95% CI, 2.4-3.5) for glycopeptides, 2.2 (95% CI, 1.7-2.9) for cephalosporins and 1.9 (95% CI, 1.7-2.2) for other beta-lactams. Significant heterogeneity was detected among studies. A regression analysis revealed that the heterogeneity was linked to the length of time in which antibiotic exposure was detected before MRSA isolation (more or less than 180 days).


CONCLUSIONS
This meta-analysis shows a clear association between exposure to antibiotics and MRSA isolation. This information may be useful for researchers in designing future studies and for policy decision-making on the appropriate management of antibiotic therapies.
Tacconelli
Evelina
E
Department of Infectious Diseases, Catholic University, Rome, Italy. etacconelli@rm.unicatt.it
De Angelis
Giulia
G
Cataldo
Maria A
MA
Pozzi
Emanuela
E
Cauda
Roberto
R
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003428:Cross Infection; D006801:Humans; D016106:Methicillin Resistance; D012306:Risk; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents