The prevalence and risk factors of methicillin-resistant Staphylococcus aureus in long-term-care facilities : a systematic review

Abstract

Background: Methicillin-resistant Staphylococcus aureus(MRSA) is a well-recognized nosocomial agent in hospital setting, but few data about the epidemiology of MRSA in long-term care facilities are available. The aim of the study is to overview the prevalence and risk factors for MRSA carriage in an endemic situation in long-term care facilities (LTCF)settings. Methods: A keyword search was conducted in the PubMed and Medline database(January 2004through May 2014). Titles and abstracts were screened to identify the studies on MRSA prevalence and risk factors for carriage in patients in non-outbreak situations in LTCF settings. The quality of the included studies are evaluated by seven criteria(outcome definition, time unit, target population, participants, observer bias, screening procedure, swabbing sites) and referred as ‘good’, ‘fair’ and ‘poor’. Results: Twenty one observational papers were included in the review. Two of them were categorized as good quality. MRSA prevalence rates varied over a wide range, from 0% to 58%.Several factors are associated to MRSA colonization, which are host-related (such as advanced age, poor functional status, and comorbidities), antecedents (such as prior MRSA colonization, prior antibiotic therapy, prior hospitalization and transferal between acute-care hospital and LTCF) and facility specific characteristics. Conclusions: This review suggested that a wide variation of MRSA colonization among LTCFs, one of the possible causes was due to different methodological differences between studies. A standardized recommendation on swabbing sites and outcome calculations for prevalence study is needed in order to allow comparison among different healthcare settings. A better understand of risk factors for MRSA in healthcare facilities to develop a targeted infection control strategy for facilities associated colonization.