Risk factors for methicillin-resistant Staphylococcus aureus colonization in the neonatal intensive care unit: A systematic review and meta-analysis

Context: Methicillin-resistant Staphylococcus aureus (MRSA) causes a significant burden of illness in neonatal intensive care units (NICUs) worldwide. Identifying infants colonized with MRSA has become an important infection control strategy to interrupt nosocomial transmission.

Objective: Assess risk factors for MRSA colonization in NICUs via a systematic review and meta-analysis.

Data sources: MEDLINE, Embase, Web of Science, and The Cochrane Library databases were searched from inception through September 2015.

Study selection: Studies reporting risk factors for MRSA colonization using noncolonized controls in subspecialty level III or IV NICUs were included.

Data extraction: Two authors independently extracted data on MRSA colonization risk factors, study design, and MRSA screening methodology.

Results: Eleven articles were included in the systematic review, with 10 articles analyzed via meta-analysis. MRSA colonization was associated with gestational age <32 weeks (odds ratio [OR], 2.67; 95% confidence interval [CI], 1.35-5.27; P = .01) and birth weight <1,500 g (OR, 2.63; 95% CI, 1.25-5.55; P = .01). Infant sex (P = .21), race (P = .06), inborn status (P = .09), and delivery type (P = .24) were not significantly associated with colonization.

Conclusions: Very preterm and very-low birth weight infants were identified as having an increased risk for MRSA colonization on meta-analysis. Multifaceted infection prevention strategies should target these high-risk infants to reduce MRSA colonization rates in NICUs.