Risks for Staphylococcus aureus colonization in patients with psoriasis: a systematic review and meta-analysis.
Evidence on whether patients with psoriasis have a higher risk for staphylococcal colonization than healthy controls remains controversial. To synthesize the current literature, we performed a systematic review on the prevalence and relative risk (RR) of Staphylococcus aureus colonization in patients with psoriasis. We modified the QUADAS-2 instrument to assess the reporting quality of individual studies and applied random-effects models in meta-analysis. Overall we identified 21 eligible studies, of which 15 enrolled one or more comparison groups. The pooled prevalence of staphylococcal colonization in patients with psoriasis was 35·3% [95% confidence interval (CI) 25·0-45·6] on lesional skin and 39·2% (95% CI 33·7-44·8) in the nares. Patients with psoriasis were 4·5 times more likely to be colonized by S. aureus than healthy controls were on the skin (RR 5·54, 95% CI 3·21-9·57) and 60% more in the nares (RR 1·60, 95% CI 1·11-2·32). Cutaneous and nasal colonization by meticillin-resistant S. aureus also appeared higher in patients with psoriasis (pooled prevalence 8·6%) than in healthy controls (2·6%), yet the difference was not statistically significant (P = 0·74). In contrast, despite of a similar risk for nasal staphylococcal colonization (RR 0·67, 95% CI 0·38-1·18), patients with psoriasis were less likely to carry S. aureus on lesional skin than atopic patients (RR 0·64, 95% CI 0·40-1·02). In summarizing the current literature, we found that patients with psoriasis were at an increased risk for staphylococcal colonization compared with healthy individuals. Prospective studies on how bacterial loads correlate with disease activity can guide the clinical management of bacterial colonization while preventing the emergence of drug-resistant strains.
Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan.|College of Medicine, Chang Gung University, Gueishan District, Taoyuan City, Taiwan.|Graduate Institute of Clinical Medical Sciences, Chang Gung University, Gueishan District, Taoyuan City, Taiwan.
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Ng
Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan.|College of Medicine, Chang Gung University, Gueishan District, Taoyuan City, Taiwan.
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Huang
College of Medicine, Chang Gung University, Gueishan District, Taoyuan City, Taiwan.
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Chu
College of Medicine, Chang Gung University, Gueishan District, Taoyuan City, Taiwan.
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Wu
College of Medicine, Chang Gung University, Gueishan District, Taoyuan City, Taiwan.|Department of Family Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan.
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http://orcid.org/0000-0002-1151-7983
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Liu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications*; D013203:Staphylococcal Infections / Q000209:etiology*; D013207:Staphylococcal Skin Infections / Q000209:etiology*; D013211:Staphylococcus aureus; D055815:Young Adult