Bohjanen Sara, Goldstick Connor, Hordinsky Maria
Department of Dermatology, University of Minnesota, Minneapolis, MN, USA.
Department of Economics, University of California San Diego, San Diego, CA, USA.
Infect Control Hosp Epidemiol. 2025 Apr 16;46(7):1-5. doi: 10.1017/ice.2025.58.
To improve the understanding of appropriate antibiotic de-escalation and stewardship by consolidating the evidence on screening for methicillin-resistant (MRSA) colonization of the nares to predict MRSA in acute skin and soft tissue infections (SSTIs).
This meta-analysis was performed according to PRISMA guidelines. Six databases were searched by two reviewers for articles on MRSA detection in the nares and acute SSTIs. The quality and risk of bias of the articles were then assessed. The primary outcomes of interest were pooled sensitivity and specificity. Sub-analyses were also performed to test for heterogeneity.
After screening 1040 records, 15 articles (n = 1,970) were included in the meta-analysis. Using MRSA nares screening to predict MRSA in acute SSTIs had an overall specificity of 0.949 and sensitivity of 0.474. With a prevalence of 29.1%, the calculated NPV was 0.815. There were sub-analyses on various study variables, such as study location, participant age, and detection by polymerase chain reaction versus culture. The only significant finding was an increased sensitivity for adults (0.543) compared to pediatric participants (0.285).
To our knowledge, this is the first meta-analysis that focuses on the performance of MRSA nares screening for predicting MRSA infection in patients presenting with acute SSTIs. The baseline prevalence of MRSA SSTIs is important for interpreting the screening results, and the prevalence is influenced by geography and patient factors. This clinical context must be considered before utilizing MRSA nares screening for acute SSTIs.
通过整合关于筛查鼻腔耐甲氧西林金黄色葡萄球菌（MRSA）定植以预测急性皮肤和软组织感染（SSTIs）中MRSA的证据，提高对适当抗生素降阶梯治疗和管理的认识。
本荟萃分析按照PRISMA指南进行。两名研究者在六个数据库中检索关于鼻腔MRSA检测和急性SSTIs的文章。然后评估文章的质量和偏倚风险。主要关注的结果是合并敏感性和特异性。还进行了亚组分析以检验异质性。
在筛选1040条记录后，15篇文章（n = 1970）纳入荟萃分析。使用鼻腔MRSA筛查预测急性SSTIs中的MRSA，总体特异性为0.949，敏感性为0.474。患病率为29.1%时，计算出的阴性预测值为0.815。对各种研究变量进行了亚组分析，如研究地点、参与者年龄以及聚合酶链反应与培养检测。唯一显著的发现是，与儿科参与者（0.285）相比，成人的敏感性增加（0.543）。
据我们所知，这是第一项专注于鼻腔MRSA筛查在预测急性SSTIs患者中MRSA感染表现的荟萃分析。MRSA SSTIs的基线患病率对于解释筛查结果很重要，且患病率受地理位置和患者因素影响。在将鼻腔MRSA筛查用于急性SSTIs之前，必须考虑这一临床背景。
