title: MRSA and VRE colonization in solid organ transplantation: a meta-analysis of published studies.
abstract: The burden of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) colonization among the increasing number of solid organ transplant patients has not been systematically explored. We searched PubMed and EMBASE for pertinent articles, performed a meta-analysis of prevalence across eligible studies and estimated the risk of ensuing MRSA or VRE infections relative to colonization status. We stratified effects in the pretransplant and posttransplant period. Twenty-three studies were considered eligible. Seventeen out of 23 (74%) referred to liver transplants. Before transplantation, the pooled prevalence estimate for MRSA and VRE was 8.5% (95% confidence interval [CI] 3.2–15.8) and 11.9% (95% CI 6.8–18.2), respectively. MRSA estimate was influenced by small studies and was lower (4.0%; 95% CI 0.4–10.2) across large studies (>200 patients). After transplantation, the prevalence estimates were 9.4% (95% CI 3.0–18.5) for MRSA and 16.2% (95% CI 10.7–22.6) for VRE. Pretransplant as well as posttransplant MRSA colonization significantly increased the risk for MRSA infections (pooled risk ratio [RR] 5.51; 95% CI 2.36–12.90 and RR 10.56; 95% CI 5.58–19.95, respectively). Pretransplant and posttransplant VRE colonization were also associated with significant risk of VRE infection (RR 6.65; 95% CI 2.54–17.41 and RR 7.93; 95% CI 2.36–26.67, respectively). Solid organ transplantation is a high-risk setting for MRSA and VRE colonization, and carrier state is associated with infection. Upgraded focus in prevention and eradication strategies is warranted.
authors.forename: P D
authors.initials: PD
authors.lastname: Ziakas
authors.forename: E E
authors.initials: EE
authors.lastname: Pliakos
authors.forename: F N
authors.initials: FN
authors.lastname: Zervou
authors.forename: B M
authors.initials: BM
authors.lastname: Knoll
authors.forename: L B
authors.initials: LB
authors.lastname: Rice
authors.forename: E
authors.initials: E
authors.lastname: Mylonakis
mesh_terms: D002353:Carrier State; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D017093:Liver Failure / Q000150:complications; D016031:Liver Transplantation / Q000009:adverse effects; D055624:Methicillin-Resistant Staphylococcus aureus; D016377:Organ Transplantation / Q000009:adverse effects; D015995:Prevalence; D012306:Risk; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology*; D016896:Treatment Outcome; D020713:Vancomycin Resistance; D065507:Vancomycin-Resistant Enterococci