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PloS One 2019To comprehensively determine the prevalence of MRSA in healthy Chinese population, the influencing factors of MRSA colonization and its antibiotic resistance. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To comprehensively determine the prevalence of MRSA in healthy Chinese population, the influencing factors of MRSA colonization and its antibiotic resistance.
METHODS
Articles that studied prevalence or influencing factors of MRSA carriage in healthy Chinese population were retrieved from PubMed, Ovid database, three Chinese electronic databases. The pooled prevalence of MRSA, its antibiotic resistance and influencing factors were analyzed by STATA12.0.
RESULTS
37 studies were included. The pooled prevalence of MRSA was 21.2% (95% CI: 18.5%-23.9%), and the prevalence of S.aureus was 15% (95% CI: 10%-19%), with a significant heterogeneity (MRSA: I2 = 97.6%, P<0.001; S.aureus: I2 = 98.4%, P < 0.001). In subgroup analysis, the pooled prevalence of MRSA was 28% (95%CI: 10%-51%) for Livestock-related workers, 18% (95%CI: 11%-26%) for children, 20% (95%CI: 12%-29%) for healthcare workers, 7% (95%CI: 3%-13%) for community residents. The prevalence of MRSA in studies with oxacillin disk diffusion method (28%, 95%CI: 21%-35%) seemed higher than that with the mecA gene method(12%, 95%CI: 7%-19%). MRSA in studies conducted in Taiwan was more common than in Mainland China and Hong Kong. Similar results were found in meta-regression. Influencing factors for MRSA colonization were noted in seven eligible studies, they included younger age (OR: 3.54, 95% CI: 2.38-5.26; OR: 2.24, 95% CI: 1.73-2.9), attending day care centers (DCCs) (OR: 1.95, 95% CI: 1.4-2.72; OR: 1.53, 95% CI: 1.2-1.95), flu vaccination (OR:1.73, 95% CI: 1.28-2.35), using antibiotics within the past year (OR: 2.05, 95% CI:1.35-3.11), residing in northern Taiwan (OR: 1.45, 95% CI: 1.19-1.77), regular visits to health care facility (OR: 23.83, 95% CI: 2.72-209.01), household member working in health care facility (OR: 8.98, 95% CI:1.4-55.63), and contact with livestock (OR: 6.31, 95% CI: 3.44-11.57). Moreover, MRSA was found to be highly resistant to penicillin, ampicillin, erythromycin, and clindamycin, with a pooled resistance ratio of 100, 93, 88, and 75%, respectively. However, no resistance were noted to vancomycin.
CONCLUSION
The pooled prevalence of MRSA was considerably high in health Chinese population. Additionally, these strains showed extreme resistance to penicillin, ampicillin, erythromycin and clindamycin. Public MRSA protection measures and the surveillance of MRSA should be strengthened to reduce the spread of MRSA among hospitals, communities, and livestock.
Topics: Carrier State; Healthy Volunteers; Humans; Methicillin-Resistant Staphylococcus aureus; Odds Ratio; Population Surveillance; Prevalence; Staphylococcal Infections
PubMed: 31647842
DOI: 10.1371/journal.pone.0223599 -
Scientific Reports Nov 2020The accessory gene regulator (agr) locus of Staphylococcus aureus is a quorum-sensing virulence regulator. Although there are many studies concerning the effect of... (Meta-Analysis)
Meta-Analysis
The accessory gene regulator (agr) locus of Staphylococcus aureus is a quorum-sensing virulence regulator. Although there are many studies concerning the effect of dysfunctional agr on the outcomes of S. aureus infection, there is no systematic review to date. We systematically searched for clinical studies reporting outcomes of invasive S. aureus infections and the proportion of dysfunctional agr among their causative strains, and we performed a meta-analysis to obtain estimates of the odds of outcomes of invasive S. aureus infection with dysfunctional versus functional agr. Of 289 articles identified by our research strategy, 20 studies were meta-analysed for crude analysis of the impact of dysfunctional agr on outcomes of invasive S. aureus infection. Dysfunctional agr was generally associated with unfavourable outcomes (OR 1.32, 95% CI 1.05-1.66), and the impact of dysfunctional agr on outcome was more prominent in invasive methicillin-resistant S. aureus (MRSA) infections (OR 1.54, CI 1.20-1.97). Nine studies were meta-analysed for the impact of dysfunctional agr on the 30-day mortality of invasive S. aureus infection. Invasive MRSA infection with dysfunctional agr exhibited higher 30-day mortality (OR 1.40, CI 1.03-1.90) than that with functional agr. On the other hand, invasive MSSA infection with dysfunctional agr exhibited lower 30-day mortality (OR 0.51, CI 0.27-0.95). In the post hoc subgroup analysis by the site of MRSA infection, dysfunctional agr was associated with higher 30-day mortality in MRSA pneumonia (OR 2.48, CI 1.17-5.25). The effect of dysfunctional agr on the outcome of invasive S. aureus infection may vary depending on various conditions, such as oxacillin susceptibility and the site of infection. Dysfunctional agr was generally associated with unfavourable clinical outcomes and its effect was prominent in MRSA and pneumonia. Dysfunctional agr may be applicable for outcome prediction in cases of invasive MRSA infection with hardly eradicable foci such as pneumonia.
Topics: Bacterial Proteins; Humans; Methicillin-Resistant Staphylococcus aureus; Prognosis; Staphylococcal Infections; Virulence Factors
PubMed: 33244173
DOI: 10.1038/s41598-020-77729-0 -
Journal of the Association of Medical... Jan 2024Prolonged intravenous (IV) antibiotic therapy may not be optimal for people who inject drugs (PWID) with infective endocarditis (IE) due to unique social and medical...
BACKGROUND
Prolonged intravenous (IV) antibiotic therapy may not be optimal for people who inject drugs (PWID) with infective endocarditis (IE) due to unique social and medical needs. The role of partial IV antibiotic therapy with continued oral (PO) antibiotic therapy is unclear.
METHODS
A systematic review was performed using EMBASE and MEDLINE databases. Included studies compared PO to IV antibiotic treatment for IE in PWID.
RESULTS
Four studies met eligibility. Observational studies included full IV treatment groups and partial IV, partial PO treatment groups for severe injection-related infections. PWID with IE comprised 41.0%-64.7% of the study populations but outcomes specific to IE were not separately reported. All-cause 90-day readmission rates were comparable between the IV treatment group (27.9%-31.5%) and partial IV, partial PO treatment group (24.8%-32.5%). Ninety-day mortality was non-significantly different between IV treatment (4.9%-10.7%) and partial IV, partial PO treatment groups (2.4%-13.0%). One small randomized clinical trial compared IV oxacillin or vancomycin with gentamicin to PO ciprofloxacin plus rifampin. The cure rates were 91% and 90%, respectively.
CONCLUSION
There is limited evidence comparing IV treatment to partial IV, partial PO antibiotic treatment in PWID with IE. Observational studies suggest that PO antibiotic therapy after initial IV treatment may be equivalent to full IV treatment alone within specific parameters, but randomized trials are needed to inform recommendations. Substantial clinical and social benefits for PWID and advantages for the health care system will result if PO treatment strategies with equal efficacy can be implemented.
PubMed: 38250624
DOI: 10.3138/jammi-2023-0013