The risk of infection after nasal colonization with Staphylococcus aureus.
OBJECTIVE
Nasal, axillary, or inguinal colonization with Staphylococcus aureus generally precedes invasive infection. Some studies have found that colonization with methicillin-resistant S. aureus (MRSA) poses a greater risk of clinical infection than colonization with methicillin-susceptible S. aureus (MSSA). However, the magnitude of risk is unclear.


METHODS
We undertook a systematic review to provide an overall estimate of the risk of infection following colonization with MRSA compared with colonization by MSSA. Ten observational studies, with a total of 1170 patients, were identified that provided data on both MSSA and MRSA colonization and infection. A random-effects model was used to obtain pooled estimates of the odds ratio and 95% confidence interval.


RESULTS
Overall, colonization by MRSA was associated with a 4-fold increase in the risk of infection (odds ratio 4.08, 95% confidence interval, 2.10-7.44). Studies differed in the choice of patient population, severity of illness, and frequency of sampling to detect colonization.


CONCLUSIONS
Further research is needed to identify effective methods for sustained eradication of MRSA carriage to reduce the high risk of subsequent infection.
Safdar
Nasia
N
Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Madison, WI 53792, USA. ns2@medicine.wisc.edu
Bradley
Elisa A
EA
D015331:Cohort Studies; D015169:Colony Count, Microbial; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015201:Meta-Analysis as Topic; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D009296:Nasal Cavity / Q000382:microbiology*; D009297:Nasal Mucosa / Q000382:microbiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*