title: Prevalence and invasiveness of community-acquired methicillin-resistant Staphylococcus aureus: a meta-analysis.
abstract: BACKGROUND
  Reports suggest that the prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has increased, and that CA-MRSA is more virulent than healthcare-associated (HA)-MRSA.
  
  
  OBJECTIVE
  The aim of this study is to gain a better understanding of the invasiveness and prevalence of CA-MRSA in patients; we systematically reviewed the literature by conducting a meta-analysis.
  
  
  METHODS
  We searched the MEDLINE and PUBMED databases from the year these databases were established to January 2013.
  
  
  RESULTS
  The pooled CA-MRSA prevalence among 50,737 patients from 33 studies was 39.0% (range, 30.8-47.8%). The pooled CA-MRSA prevalence rates among pediatric and adult patients with MRSA infection were 50.2% (range, 37.5-62.8%) and 42.3% (range, 16.4-73.3%), respectively. The pooled CA-MRSA prevalence rates of MRSA-infected patients in Asia, Europe, and North America were 23.1% (range, 12.0-39.8%), 37.4% (range, 21.1-56.4%), and 47.4% (range, 35.8-59.4%), respectively. Using the random effects model, we determined that the pooled odds ratio of invasive infections in CA- and HA-MRSA was 0.30 (95% confidence interval: 0.08-1.10; P = 0.07, test for heterogeneity P < 0.00001).
  
  
  CONCLUSIONS
  The prevalence of CA-MRSA in MRSA infection varied with area and population. No difference in the ability to cause invasive infections was found between CA- and HA-MRSA. This finding challenges the view that CA-MRSA is more virulent than HA-MRSA.
authors.forename: Shipeng
authors.initials: S
authors.lastname: Li
authors.forename: Juan
authors.initials: J
authors.lastname: Li
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Qiao
authors.forename: Xue
authors.initials: X
authors.lastname: Ning
authors.forename: Ting
authors.initials: T
authors.lastname: Zeng
authors.affiliation: Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
authors.forename: Xuzhuang
authors.initials: X
authors.lastname: Shen
mesh_terms: D000328:Adult; D001208:Asia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D016920:Meningitis, Bacterial / Q000453:epidemiology / Q000382:microbiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D009656:North America / Q000453:epidemiology; D015995:Prevalence; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*