title: Fecal Carriage of Staphylococcus aureus in the Hospital and Community Setting: A Systematic Review.
abstract: OBJECTIVE
  Staphylococcus aureus fecal carriage has been identified as a potential source for nosocomial transmission and a risk factor for disease development. This systematic review determined the overall S. aureus [including methicillin susceptible and resistant S. aureus (MSSA and MRSA)] fecal carriage rates within the community and healthcare settings.
  
  
  METHODS
  Peer-reviewed articles indexed in Medline, Scopus, Academic Search Premier, Africa-Wide Information, CINAHL, and Web of Science were identified using applicable and controlled vocabulary through to 11 November 2015. Eligible studies were ascertained by three independent reviewers. Random-effects meta-analyses of proportions were performed to determine S. aureus, MSSA and MRSA fecal carriage rates reported by eligible studies.
  
  
  RESULTS
  Twenty six studies were included in this review. The pooled estimates for S. aureus, MSSA and MRSA fecal carriage were 26% (95% confidence interval (CI): 16.8-36.3%), 86% (95% confidence interval (CI): 65.9-97.9%) and 10% (95% CI: 0.7-27.0%), respectively. Fecal S. aureus carriage rates increased on average from 10 to 65% during the first 8 weeks of life, followed by an average carriage rate of 64% at 6 months and 46% at 1 year of life. Genotyping techniques were employed mainly in studies conducted in developed countries and comprised largely of gel-based techniques. Six studies reported on the role of S. aureus fecal strains in diarrhea (n = 2) and the risk for acquiring infections (n = 4). Eight of the 26 studies included in this review performed antibiotic susceptibility testing of S. aureus fecal isolates.
  
  
  CONCLUSIONS
  This study provides evidence that screening for S. aureus fecal carriage, at least in populations at high risk, could be an effective measure for the prevention of S. aureus transmission and infection in the healthcare and community setting. More well-structured studies need to be conducted and sequence-based genotyping techniques should be employed for the comparison of isolates on a global scale in both developing and developed countries.
authors.affiliation: Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town Cape Town, South Africa.
authors.forename: Shantelle
authors.initials: S
authors.lastname: Claassen-Weitz
authors.affiliation: Department of Microbiology, Obafemi Awolowo University Ile-Ife, Nigeria.
authors.forename: Adebayo O
authors.initials: AO
authors.lastname: Shittu
authors.affiliation: Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town Cape Town, South Africa.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Ngwarai
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University Hamilton, ON, Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape TownCape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape TownCape Town, South Africa; National Health Laboratory Service of South Africa, Groote Schuur HospitalCape Town, South Africa.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Nicol
authors.affiliation: Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape TownCape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape TownCape Town, South Africa.
authors.forename: Mamadou
authors.initials: M
authors.lastname: Kaba
keywords: Staphylococcus aureus; carriage; community; fecal; systematic review