MRSA carriage among healthcare workers in non-outbreak settings in Europe and the United States: a systematic review

Abstract

AbstarctBackgroundA recent review estimated prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare workers (HCWs) to be 4.6%. However, MRSA carriage in HCWs in non-outbreak settings is thought to be higher than in an outbreak situation, due to increased hygiene awareness in outbreaks, but valid data are missing. The goals of this paper are to summarise the prevalence of MRSA carriage amongst HCWs in non-outbreak situations and to identify occupational groups in healthcare services associated with a higher risk of MRSA colonisation.MethodsA systematic search for literature was conducted in the MEDLINE and EMBASE databases. The methodological quality of the studies was assessed using seven criteria. Pooled prevalence rates were calculated. Pooled effect estimates were identified in a meta-analysis.Results31 studies were included in this review. The pooled MRSA colonisation rate was 1.8% (95% confidence interval [CI], 1.34%-2.50%). The rate increased to 4.4% (95% CI, 3.98%-4.88%) when one study from the Netherlands was excluded. The pooled MRSA rate was highest in nursing staff (6.9%). Nursing staff had an odds ratio of 1.72 (95% CI, 1.07-2.77) when compared with medical staff and an odds ratio of 2.58 (95%, 1.83-3.66) when compared with other healthcare staff. Seven studies were assessed as being of high quality. The pooled MRSA prevalence in high quality studies was 1.1% or 5.4% if the one large study from the Netherlands is not considered. The pooled prevalence in studies of moderate quality was 4.0%.ConclusionsMRSA prevalence among HCWs in non-outbreak settings was no higher than carriage rates estimated for outbreaks. Our estimate is in the lower half of the range of the published MRSA rates in the endemic setting. Our findings demonstrate that nursing staff have an increased risk for MRSA colonisation. In order to confirm this finding, more studies are needed, including healthcare professionals with varying degrees of exposure to MRSA. In order to reduce misclassification bias, standardisation of HCWs screening is warranted.

Antibiograms, toxin profiling and molecular typing of Staphylococcus aureus isolates from two tertiary hospitals in Jordan

“…In contrast to these results, in Skane county of southern Sweden, the reported cases of MRSA were less than in the southern Europe Counties, however, the incidence of MRSA infection was rising as the number of cases increased from 31 in year 2000 to 315 cases in year 2010 [25]. In USA, prevalence of MRSA approached 60% of the S. aureus isolates in 2003 [27]. In India, the proportion of CA-MRSA in children <5 years was 73.7% [28].…”

Staphylococcus Infections in Pregnancy

“…Studies place the incidence of MRSA among healthcare staff around 5%, with reported rates of up to 15% in nonoutbreak settings. 30,31 The highest rates are found among nursing staff, who are likely to have the closest physical contact with infected patients. 31 The evidence does not support the idea that elevated rates of nasal carriage among healthcare workers are a primary cause of MRSA outbreaks, although unrecognized carriage coupled with poor infection control procedures can lead to infection.…”

“…30,31 The highest rates are found among nursing staff, who are likely to have the closest physical contact with infected patients. 31 The evidence does not support the idea that elevated rates of nasal carriage among healthcare workers are a primary cause of MRSA outbreaks, although unrecognized carriage coupled with poor infection control procedures can lead to infection. 32,33 It is not standard of care to screen hospital or clinic staff unless an association with an outbreak is suspected.…”

Antimicrobial Resistance and Molecular Characteristics of Methicillin-Resistant <i>Staphylococcus aureus</i> Isolates from Child Patients of High-Risk Wards in Shenzhen, China

“…In addition, S. aureus strains isolated from medical staff were reported to be closely related to those isolated from inpatients (40). Results of our study showed that 10 MRSA isolates from the neonatal department shared similar PFGE types, out of which 1 was isolated from a paramedic and the other 9 were isolated from neonatal patients.…”