Esemu Seraphine Nkie, Bowo-Ngandji Arnol, Ndip Roland Ndip, Akoachere Jane-Francis Tatah Kihla, Keneh Nene Kaah, Ebogo-Belobo Jean Thierry, Kengne-Ndé Cyprien, Mbaga Donatien Serge, Tendongfor Nicholas, Gonsu Hortense Kamga, Assam Jean Paul Assam, Ndip Lucy Mande
Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
Department of Microbiology and Parasitology, Laboratory for Emerging Infectious Diseases, University of Buea, Buea, Cameroon.
J Glob Infect Dis. 2024 Dec 21;16(4):160-182. doi: 10.4103/jgid.jgid_95_24. eCollection 2024 Oct-Dec.
Methicillin-resistant (MRSA) colonization in neonatal intensive care units (NICUs) is a significant global health concern, leading to severe infections, extended hospital stays, and substantial economic burdens on health-care systems. To develop effective infection control strategies, we need to fill existing gaps in our understanding of MRSA epidemiology in neonates. The aim of this systematic review is to provide an extensive analysis of the proportion of MRSA colonizations in NICUs.
We used a comprehensive search strategy across databases such as Medline, Embase, Global Health, Web of Science, and Global Index Medicus, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were independently reviewed and selected based on a variety of criteria, including the inclusion of neonates tested for MRSA colonization during NICU stay, and the reporting of community-acquired and hospital-acquired MRSA (CA-MRSA and HA-MRSA) incidence levels. Exclusion criteria included studies outside NICUs, those focused on specific MRSA outbreaks or clinical infections, review studies, and those lacking abstracts or full texts. Five authors independently extracted data, which was summarized and checked for quality. Statistical analysis included a random-effects model to compute pooled proportions, stratification by geographical location, evaluation of heterogeneity, and examination of publication bias.
Our systematic review evaluated 62 studies out of an initial 536 records identified. The majority of the selected studies were conducted in high-income countries, primarily in the United States. From these studies, we estimated a cumulative incidence rate of 7.2% for MRSA colonization in NICUs. When the source of MRSA was considered, CA-MRSA incidence was 2.7%, while HA-MRSA incidence was notably higher at 11%. A subgroup analysis showed geographical differences in the cumulative incidence of MRSA colonization in NICUs, with Brazil having the lowest incidence and Taiwan the highest. The proportion of HA-MRSA colonization also varied significantly by country, with South Korea reporting higher incidence rates than the United States. However, the differences in CA-MRSA colonization rates between countries and WHO regions were not statistically significant.
Our systematic review found a cumulative incidence of 7.2% for MRSA colonization in NICUs, with HA-MRSA (11%) being more prevalent than CA-MRSA (2.7%). Regional variations were detected, with Taiwan exhibiting the highest cumulative incidence and South Korea having both the highest CA-MRSA and HA-MRSA. These findings underline the substantial public health impact of MRSA, especially in NICUs, necessitating context-specific prevention and control strategies. Future research should strive to address these regional disparities and aspire to attain a more globally representative understanding of MRSA colonization rates.
新生儿重症监护病房（NICU）中的耐甲氧西林金黄色葡萄球菌（MRSA）定植是一个重大的全球卫生问题，会导致严重感染、住院时间延长以及给医疗系统带来巨大经济负担。为制定有效的感染控制策略，我们需要填补目前对新生儿MRSA流行病学认识上的空白。本系统评价的目的是对NICU中MRSA定植比例进行广泛分析。
我们按照系统评价和Meta分析的首选报告项目指南，在Medline、Embase、Global Health、Web of Science和Global Index Medicus等数据库中采用全面的检索策略。根据多种标准对文章进行独立评审和筛选，包括纳入在NICU住院期间接受MRSA定植检测的新生儿，以及报告社区获得性和医院获得性MRSA（CA-MRSA和HA-MRSA）发病率水平。排除标准包括NICU以外的研究、专注于特定MRSA暴发或临床感染的研究、综述研究以及缺乏摘要或全文的研究。五位作者独立提取数据，对数据进行汇总并检查质量。统计分析包括使用随机效应模型计算合并比例、按地理位置分层、评估异质性以及检查发表偏倚。
我们的系统评价对最初识别出的536条记录中的62项研究进行了评估。所选研究大多在高收入国家进行，主要是在美国。从这些研究中，我们估计NICU中MRSA定植的累积发病率为7.2%。当考虑MRSA的来源时，CA-MRSA发病率为2.7%，而HA-MRSA发病率明显更高，为11%。亚组分析显示NICU中MRSA定植累积发病率存在地理差异，巴西发病率最低，台湾地区最高。HA-MRSA定植比例在不同国家也有显著差异，韩国报告的发病率高于美国。然而，不同国家和世界卫生组织区域之间CA-MRSA定植率的差异无统计学意义。
我们的系统评价发现NICU中MRSA定植的累积发病率为7.2%，其中HA-MRSA（11%）比CA-MRSA（2.7%）更普遍。检测到区域差异，台湾地区累积发病率最高，韩国的CA-MRSA和HA-MRSA发病率均最高。这些发现强调了MRSA对公共卫生的重大影响，尤其是在NICU中，需要针对具体情况制定预防和控制策略。未来的研究应努力解决这些区域差异，并力求对MRSA定植率有更具全球代表性的认识。
