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      The prevalence of methicillin-resistant Staphylococcus aureus among diabetic patients: a meta-analysis

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          Abstract

          Aims

          Diabetic patients have multiple risk factors for colonisation with methicillin-resistant Staphylococcus aureus (MRSA), a nosocomial pathogen associated with significant morbidity and mortality. This meta-analysis was conducted to estimate the prevalence of MRSA among diabetic patients.

          Methods

          The MEDLINE, Embase, BIOSIS, and Web of Science databases were searched for studies published up to May 2018 that reported primary data on the prevalence of MRSA in 10 or more diabetic patients. Two authors independently assessed study eligibility and extracted the data. The main outcomes were the pooled prevalence rates of MRSA colonisation and infection among diabetic populations.

          Results

          Eligible data sets were divided into three groups containing data about the prevalence of MRSA colonisation or in diabetic foot or other infections. From 23 data sets, the prevalence of MRSA colonisation among 11577 diabetics was 9.20% (95% CI, 6.26–12.63%). Comparison of data from 14 studies that examined diabetic and non-diabetic patients found that diabetics had a 4.75% greater colonisation rate ( P < 0.0001). From 41 data sets, the prevalence of MRSA in 10994 diabetic foot infection patients was 16.78% (95% CI, 13.21–20.68%). Among 2147 non-foot skin and soft-tissue infections, the MRSA prevalence rate was 18.03% (95% CI, 6.64–33.41).

          Conclusions

          The prevalence of MRSA colonisation among diabetic patients is often higher than among non-diabetics; this may make targeted screening attractive. In the UK, many diabetic patients may already be covered by the current screening policies. The prevalence and impact of MRSA among diabetic healthcare workers requires further research. The high prevalence of MRSA among diabetic foot infections may have implications for antimicrobial resistance, and should encourage strategies aimed at infection prevention or alternative therapies.

          Electronic supplementary material

          The online version of this article (10.1007/s00592-019-01301-0) contains supplementary material, which is available to authorized users.

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          Most cited references87

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          Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis.

          Sara E Cosgrove, George Sakoulas, Eli Perencevich … (2003)
          A meta-analysis was performed to summarize the impact of methicillin-resistance on mortality in Staphylococcus aureus bacteremia. A search of the MEDLINE database for studies published during the period of 1 January 1980 through 31 December 2000 and a bibliographic review identified English-language studies of S. aureus bacteremia. Studies were included if they contained the numbers of and mortality rates for patients with methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) bacteremia. Data were extracted on demographic characteristics of the patients, adjustment for severity and comorbid illness, source of bacteremia, and crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for in-hospital mortality. When the results were pooled with a random-effects model, a significant increase in mortality associated with MRSA bacteremia was evident (OR, 1.93; 95% CI, 1.54-2.42; P<.001); significant heterogeneity was present. We explored the reasons for heterogeneity by means of subgroup analyses. MRSA bacteremia is associated with significantly higher mortality rate than is MSSA bacteremia.
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            Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection.

            Helen Crouch, Sharon K. Davis, C. Florez … (2004)
            Asymptomatic colonization with methicillin-resistant Staphylococcus aureus (MRSA) has been described as a risk factor for subsequent MRSA infection. MRSA is an important nosocomial pathogen but has currently been reported in patients without typical risk factors for nosocomial acquisition. This study was designed to evaluate the impact of asymptomatic nares MRSA colonization on the development of subsequent MRSA infection. The incidence of MRSA infection was examined in patients with and patients without MRSA or methicillin-susceptible S. aureus (MSSA) colonization at admission to the hospital and in those who developed colonization during hospitalization. Patients admitted to 5 representative hospital units were prospectively evaluated. Nares samples were obtained for culture at admission and during hospitalization. Laboratory culture results were monitored to identify all MRSA infections that occurred during the study period and 1 year thereafter. Of the 758 patients who had cultures of nares samples performed at admission, 3.4% were colonized with MRSA, and 21% were colonized with MSSA. A total of 19% of patients with MRSA colonization at admission and 25% who acquired MRSA colonization during hospitalization developed infection with MRSA, compared with 1.5% and 2.0% of patients colonized with MSSA (P<.01) and uncolonized (P<.01), respectively, at admission. MRSA colonization at admission increased the risk of subsequent MRSA infection, compared with MSSA colonization (relative risk [RR], 13; 95% confidence interval [CI], 2.7-64) or no staphylococcal colonization (RR, 9.5; 95% CI, 3.6-25) at admission. Acquisition of MRSA colonization also increased the risk for subsequent MRSA infection, compared with no acquisition (RR, 12; 95% CI, 4.0-38). MRSA colonization of nares, either present at admission to the hospital or acquired during hospitalization, increases the risk for MRSA infection. Identifying MRSA colonization at admission could target a high-risk population that may benefit from interventions to decrease the risk for subsequent MRSA infection.
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              Bacteriology of moderate-to-severe diabetic foot infections and in vitro activity of antimicrobial agents.

              Murray Abramson, Diane Citron, B A Lipsky … (2007)
              As part of a United States-based multicenter clinical trial, conducted from 2001 to 2004, that compared ertapenem to piperacillin-tazobactam for the treatment of moderate-to-severe diabetic foot infections (DFIs), we obtained 454 pretreatment specimens from 433 patients. After debridement, the investigators collected wound specimens, mostly by curettage or biopsy, and sent them to the R. M. Alden Research Laboratory for aerobic and anaerobic culture. Among the 427 positive cultures, 83.8% were polymicrobial, 48% grew only aerobes, 43.7% had both aerobes and anaerobes, and 1.3% had only anaerobes. Cultures yielded a total of 1,145 aerobic strains and 462 anaerobic strains, with an average of 2.7 organisms per culture (range, 1 to 8) for aerobes and 2.3 organisms per culture (range, 1 to 9) for anaerobes. The predominant aerobic organisms were oxacillin-susceptible Staphylococcus aureus (14.3%), oxacillin-resistant Staphylococcus aureus (4.4%), coagulase-negative Staphylococcus species (15.3%), Streptococcus species (15.5%), Enterococcus species (13.5%), Corynebacterium species (10.1%), members of the family Enterobacteriaceae (12.8%), and Pseudomonas aeruginosa (3.5%). The predominant anaerobes were gram-positive cocci (45.2%), Prevotella species (13.6%), Porphyromonas species (11.3%), and the Bacteroides fragilis group (10.2%). Pure cultures were noted for 20% of oxacillin-resistant Staphylococcus aureus cultures, 9.2% of Staphylococcus epidermidis cultures, and 2.5% of P. aeruginosa cultures. Two or more species of Staphylococcus were present in 13.1% of the patients. Ertapenem and piperacillin-tazobactam were each active against >98% of the enteric gram-negative rods, methicillin-sensitive S. aureus, and anaerobes. Among the fluoroquinolones, 24% of anaerobes, especially the gram-positive cocci, were resistant to moxifloxacin; 27% of the gram-positive aerobes but only 6% of the members of the family Enterobacteriaceae were resistant to levofloxacin. Moderate-to-severe DFIs are typically polymicrobial, and almost half include anaerobes. Our antibiotic susceptibility results can help to inform therapeutic choices.
              Article 0 comments Cited 113 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Joshua D. Jones: josh.jones@ed.ac.uk
                Journal
                Journal ID (nlm-ta): Acta Diabetol
                Journal ID (iso-abbrev): Acta Diabetol
                Title: Acta Diabetologica
                Publisher: Springer Milan (Milan )
                ISSN (Print): 0940-5429
                ISSN (Electronic): 1432-5233
                Publication date (Electronic): 6 April 2019
                Publication date PMC-release: 6 April 2019
                Publication date (Print): 2019
                Volume: 56
                Issue: 8
                Pages: 907-921
                Affiliations
                [1 ]ISNI 0000 0004 1936 7988, GRID grid.4305.2, Edinburgh Medical School, , University of Edinburgh, ; Chancellor’s Building, 49 Little France Crescent, EH16 4SB Edinburgh, UK
                [2 ]ISNI 0000 0004 1936 7988, GRID grid.4305.2, Division of Infection and Pathway Medicine, Edinburgh Medical School, Biomedical Sciences, , University of Edinburgh, ; Chancellor’s Building, 49 Little France Crescent, EH16 4SB Edinburgh, UK
                [3 ]ISNI 0000 0004 1759 700X, GRID grid.13402.34, International Campus, , ZJU-UoE Institute, Zhejiang University School of Medicine, Zhejiang University, ; 718 East Haizhou Road, 314400 Haining, Zhejiang People’s Republic of China
                Author notes

                Managed by Massimo Federici.

                Article
                Publisher ID: 1301
                DOI: 10.1007/s00592-019-01301-0
                PMC ID: 6597605
                PubMed ID: 30955124
                SO-VID: 0428e343-f5b0-403c-9315-55c88687aabe
                Copyright © © The Author(s) 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 13 November 2018
                Date accepted : 11 February 2019
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © Springer-Verlag Italia S.r.l., part of Springer Nature 2019

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: diabetes,diabetic patients,meta-analysis,methicillin-resistant staphylococcus aureus,mrsa,prevalence,resistance
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: diabetes, diabetic patients, meta-analysis, methicillin-resistant staphylococcus aureus, mrsa, prevalence, resistance

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