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      The global prevalence of methicillin-resistant Staphylococcus aureus colonization in residents of elderly care centers: a systematic review and meta-analysis


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          Methicillin-resistant Staphylococcus aureus (MRSA) is a difficult to treat infection, particularly in residents of elderly care centers (ECCs). Despite the substantial burden of MRSA, an inadequate number of studies have analyzed MRSA prevalence in ECCs.


          We conducted a worldwide systematic review and meta-analysis on the prevalence and risk factors of MRSA in ECCs.


          We searched MEDLINE/PubMed, EMBASE, Web of Science, and Scopus databases and the gray literature sources for all studies published between January 1980 and December 2022 on the prevalence of MRSA in ECCs. A random-effects model was utilized to estimate pooled prevalence rates at 95% confidence intervals (CI). Moreover, the data were analyzed based on World Health Organization-defined regions, income, and human development index levels.


          In total, 119 studies, including 164,717 participants from 29 countries, were found eligible for meta-analysis. The pooled global prevalence of MRSA was 14.69% (95% CI 12.39–17.15%; 16,793/164,717). Male gender [prevalence ratio (PR) = 1.55; 95% CI 1.47–1.64], previous MRSA infection (PR = 3.71; 95% CI 3.44–4.01), prior use of antibiotics (PR = 1.97; 95% CI 1.83–2.12), hospitalized within the previous year (PR = 1.32; 95% CI 1.20–1.45), have had any wound (PR = 2.38; 95% CI 2.23–2.55), have used urinary catheter (PR = 2.24; 95% CI 2.06–2.43), have used any medical device (PR = 1.78; 95% CI 1.66–1.91), and those with diabetes (PR = 1.55; CI 1.43–1.67) were more likely to be colonized by MRSA than other patients.


          Screening programs and preventive measures should target MRSA in ECCs due to the high global prevalence rates.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13756-023-01210-6.

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          Most cited references56

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          Measuring inconsistency in meta-analyses.

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            Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

            Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
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              Quantifying heterogeneity in a meta-analysis.

              The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity. Copyright 2002 John Wiley & Sons, Ltd.

                Author and article information

                Antimicrob Resist Infect Control
                Antimicrob Resist Infect Control
                Antimicrobial Resistance and Infection Control
                BioMed Central (London )
                29 January 2023
                29 January 2023
                : 12
                : 4
                [1 ]GRID grid.411495.c, ISNI 0000 0004 0421 4102, Student Research Committee, , Babol University of Medical Sciences, ; Babol, Iran
                [2 ]GRID grid.411495.c, ISNI 0000 0004 0421 4102, Department of Biostatistics and Epidemiology, School of Public Health, , Babol University of Medical Sciences, ; Babol, Iran
                [3 ]GRID grid.252749.f, ISNI 0000 0001 1261 1616, Department of Public Health and Prevention Science, School of Health Sciences, , Baldwin Wallace University, ; Berea, OH USA
                [4 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, School of Medicine, , Shiraz University of Medical Sciences, ; Shiraz, Iran
                [5 ]Harlem Medical Center, Bridgeview, IL USA
                [6 ]GRID grid.240145.6, ISNI 0000 0001 2291 4776, Department of Hematopoietic Biology and Malignancy, , The University of Texas Md Anderson Cancer Center, ; Houston, TX USA
                [7 ]GRID grid.411495.c, ISNI 0000 0004 0421 4102, Social Determinants of Health Research Center, , Health Research Institute, Babol University of Medical Sciences, ; Babol, Iran
                [8 ]GRID grid.411495.c, ISNI 0000 0004 0421 4102, Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, , Babol University of Medical Sciences, ; Babol, Iran
                © The Author(s) 2023

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                : 12 April 2022
                : 21 January 2023
                Custom metadata
                © The Author(s) 2023

                Infectious disease & Microbiology
                methicillin-resistant staphylococcus aureus,residential facilities,nursing homes,long-term care,systematic review


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