title: Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization in HIV infection: a meta-analysis.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-infected individuals who are colonized with methicillin-resistant Staphylococcus aureus (MRSA) have increased risk for MRSA infection. We conducted a meta-analysis of published studies to estimate the prevalence of MRSA colonization in this population.
  
  
  METHODS
  We performed a systematic literature review and meta-analysis. The PubMed and Embase databases were searched and studies reporting prevalence of MRSA colonization among HIV-infected individuals were included.
  
  
  RESULTS
  Among 7940 citations, 32 studies reporting data on 6558 HIV-infected individuals were considered eligible for our meta-analysis. We found that 6.9% (95% confidence interval [CI], 4.8-9.3) of individuals with HIV infection are MRSA carriers, with the corresponding figure across North American studies being 8.8% (95% CI, 6.0-12.2). History of hospitalization during the previous 12 months was associated with a 3.1 times higher risk of MRSA colonization (risk ratio [RR], 3.11 [95% CI, 1.62-5.98]). Previous or current incarceration was also associated with a higher risk for carriage (RR, 1.77 [95% CI, 1.26-2.48]). Current antiretroviral therapy or use of trimethoprim-sulfamethoxazole did not impact the risk of MRSA carriage (RR, 1.02 [95% CI, .64-1.63] and 1.45 [95% CI, .69-3.03], respectively). Extranasal screening increased the detection of MRSA colonization by at least 31.6% (95% CI, 15.8-50.0). The added yield from groin screening was 19.3% (95% CI, 11.5-28.5), from perirectal screening 18.5% (95% CI, 7.4-33.2), and from throat cultures 17.5% (95% CI, 12.0-24).
  
  
  CONCLUSIONS
  Individuals with HIV infection constitute a highly vulnerable population for MRSA colonization, and prior exposure to hospital or incarceration are significant factors. Nasal screening alone will underestimate the rate of colonization by at least one-third.
authors.affiliation: Infectious Diseases Division Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence.
authors.forename: Fainareti N
authors.initials: FN
authors.lastname: Zervou
authors.affiliation: Infectious Diseases Division Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence.
authors.forename: Ioannis M
authors.initials: IM
authors.lastname: Zacharioudakis
authors.affiliation: Infectious Diseases Division Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence.
authors.forename: Panayiotis D
authors.initials: PD
authors.lastname: Ziakas
authors.affiliation: Infectious Diseases Division Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence.
authors.forename: Josiah D
authors.initials: JD
authors.lastname: Rich
authors.affiliation: Infectious Diseases Division Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Mylonakis
mesh_terms: D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D009656:North America; D015995:Prevalence; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications* / Q000453:epidemiology*
keywords: HIV; MRSA; colonization; meta-analysis; methicillin-resistant Staphylococcus aureus