title: Non-hospital environment contamination with Staphylococcus aureus and methicillin-resistant Staphylococcus aureus: proportion meta-analysis and features of antibiotic resistance and molecular genetics.
abstract: BACKGROUND
  Staphylococcus aureus (S. aureus), including methicillin-resistant Staphylococcus aureus (MRSA), survives in dry conditions and can persist for long periods on surfaces touched by humans. Studies that estimate the proportions and characteristics of S. aureus and MRSA contamination in non-hospital environments are lacking. Therefore, we conducted a proportion meta-analysis and reviewed the features of antibiotic resistance and molecular genetics.
  
  
  METHODS
  Articles published between January 2005 and December 2015 that studied proportions of S. aureus and MRSA contamination in non-hospital environments were retrieved from the Medline database, Ovid database and Science Direct database. All statistics were analyzed by STATA 14.1.
  
  
  RESULTS
  Twenty-nine articles were included. The overall proportions of S. aureus and MRSA contamination were 41.1% (95%CI 29-54%) and 8.6% (95%CI 5-13%), respectively. The proportion of MRSA contamination increased over time. From the articles, the proportion of Panton-Valentine Leukociden (PVL) genes among MRSA isolates was 54.5%, and the proportion of the qac gene was 100.0%. Distribution of the multilocus sequence type (MLST) and pulsed-field gel electrophoresis (PFGE) of MRSA indicated that MRSA strains were from both hospitals and communities.
  
  
  CONCLUSIONS
  The overall proportions of S. aureus and MRSA contamination in non-hospital environments were high. The outcomes of antibiotic resistance and high proportions of PVL genes indicated that the antibiotic resistance of S. aureus and MRSA were notable. According to the different distributions of MLST and SCCmec of MRSA, we can infer that cross-circulation is within hospitals, communities, and livestock. The results also show that the risk from the MRSA strains was cross-transmitted among the population. High proportions of the qac gene of MRSA might indicate that current disinfection of MRSA has not been achieved, and it might be better to further identify the efficiency of the sterilization processes in a non-hospital environment so that relevant departments can take measures to improve disinfection of MRSA in non-hospital environments.
authors.affiliation: Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou 510310, China.
authors.forename: Jialing
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou 510310, China.
authors.forename: Dongxin
authors.initials: D
authors.lastname: Lin
authors.affiliation: Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou 510310, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Xu
authors.affiliation: Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou 510310, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou 510310, China.
authors.forename: Qianting
authors.initials: Q
authors.lastname: Ou
authors.affiliation: Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou 510310, China.
authors.forename: Chan
authors.initials: C
authors.lastname: Bai
authors.affiliation: Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou 510310, China. Electronic address: zhjyao2001@yahoo.com.
authors.forename: Zhenjiang
authors.initials: Z
authors.lastname: Yao
mesh_terms: D004352:Drug Resistance, Microbial; D004784:Environmental Monitoring; D004785:Environmental Pollutants / Q000302:isolation & purification; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*
chemical_list: D004785:Environmental Pollutants
keywords: Contamination; Environment; Meta-analysis; Methicillin-resistant Staphylococcus aureus; Staphylococcus aureus