Prevalence and risk factors of community-associated methicillin-resistant Staphylococcus aureus carriage in Asia-Pacific region from 2000 to 2016: a systematic review and meta-analysis
Received 24 December 2017
Accepted for publication 8 March 2018
Published 12 October 2018 Volume 2018:10 Pages 1489—1501
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Professor Irene Petersen
Jonathan WH Wong,1 Margaret Ip,2 Arthur Tang,3 Vivian WI Wei,1 Samuel YS Wong,1 Steven Riley,4 Jonathan M Read,5,6,* Kin On Kwok1,7,8,*
1Faculty of Medicine, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; 2Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; 3Department of Software, Sungkyunkwan University, Seoul, South Korea; 4MRC Centre for Outbreak Analysis and Modelling, Department for Infectious Disease Epidemiology, Imperial College London, UK; 5Centre for Health Informatics Computing and Statistics, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK; 6Institute of Infection and Global Health, The Farr Institute@HeRC, University of Liverpool, Liverpool, UK; 7Faculty of Medicine, Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, Hong Kong Special Administrative Region, China; 8Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China
*These authors contributed equally to this work
Objective: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging global public health threat. In response to a highlighted strategic priority of the World Health Organization Global Action Plan on Antimicrobial Resistance, to “strengthen the knowledge and evidence base through surveillance and research”, we synthesized published articles to estimate CA-MRSA carriage prevalence in the Asia-Pacific region.
Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD:42017067399). We searched MEDLINE, EMBASE, and PubMed for articles published from 1 January 2000 to 19 May 2017, which reported CA-MRSA carriage (defined as either colonization or infection) in Asia-Pacific region from 2000 to 2016. Studies were stratified according to settings (community or hospital where CA-MRSA was isolated) and study populations (general public or subpopulations with specified characteristics). Ranges of CA-MRSA carriage prevalence were reported for study groups.
Results: In total, 152 studies were identified. Large diversity was observed among studies in most study groups. In community-level studies, the CA-MRSA carriage prevalence among the general public ranged from 0% to 23.5%, whereas that ranged from 0.7% to 10.4% in hospital settings. From community-level studies, countries with the highest prevalence were India (16.5%–23.5%), followed by Vietnam (7.9%) and Taiwan (3.5%–3.8%). Children aged ≤6 (range: 0.5%–40.3%) and household members of CA-MRSA carriers (range: 13.0%–26.4%) are subgroups without specific health conditions but with much higher CA-MRSA carriage when compared to the general population.
Conclusion: Our CA-MRSA prevalence estimates serve as the baseline for future national and international surveillance. The ranges of prevalence and characteristics associated with CA-MRSA carriage can inform health authorities to formulate infection control policies for high-risk subgroups. Future studies should explore the heterogeneities in CA-MRSA carriage prevalence among subgroups and countries to clarify the predominant transmission mechanisms in Asia-Pacific and other regions.
Keywords: antimicrobial resistance, emerging global health threat, population studies, methicillin-resistant Staphylococcus aureus
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