Prevalence and risk factors of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) carriage in Asia-Pacific region from 2000 to 2016: A systematic review and meta-analysis
Other conference paper


Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging global public health threat, causing ranges of mild and life-threating invasive infections related to skin, soft tissues and respiratory system among people with minimal exposure towards hospital setting. Although increasing number of CA-MRSA cases and outbreaks have been reported in Asia-Pacific region, to our knowledge there has no systematic study to provide quantitative data of CA-MRSA carriage in this region. In response to a highlighted strategic priority of the World Health Organization Global Action Plan on Antimicrobial Resistance, to "strengthen the knowledge and evidence base (of MRSA) through surveillance and research", and given the strong connectivity among countries within the region and with other countries, understanding the prevalence of CA-MRSA carriage among population subgroups in the Asia-Pacific region could benefit the mitigation of the global transmission of CA-MRSA.

Methods and Materials
Search strategy
A systematic review was conducted following in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
We searched MEDLINE, EMBASE, and PubMed for articles published from 2000 to 2017 that reported CA-MRSA carriage in Asia-Pacific region from 2000 to 2016.
Studies were stratified according to (1) setting and (2) study population.
Primary outcomes
Population-level and subgroups-level of CA-MRSA carriage prevalence in the Asia-Pacific region.
Selection criteria
Titles and abstracts were screened by reviewers for the relevance of CA-MRSA in the Asia-Pacific region.
Retrieved Chinese and English studies that reported information on either CA-MRSA carriage prevalence or risk factors among the general population or subgroups between 2000 and 2016 were included.
Statistical analysis
Prevalence estimated was stabilized using the Freeman-Tukey transformation. Pooled estimates of CA-MRSA carriage prevalence were generated with DerSimonian-Laird binary random-effects models.
All analyses were performed using statistical software OpenMeta[Analyst] developed by the Center for Evidence Synthesis of Brown Universtiy in the US.

Retrieved articles and studies
We identified 1,075 articles from the initial search: 573 articles were unique records and 293 were excluded based on their titles and abstracts. Hence, 280 full-text articles were assessed for eligibility. Based on the selection criteria, a further 146 articles were excluded. Therefore, 134 articles were included in our final dataset.
The 134 identified articles reported a total of 153 studies.

General community prevalence
The pooled prevalence among the general public in community settings was 5.0% (95% CI 2.2, 8.8; Range 0.3%-23.5%). The country with the highest community setting prevalence was India (19.5%; 95% CI 13.1, 26.7), followed by Vietnam (7.9%;95% CI 6.3, 9.6) and Taiwan (3.7%; 95% CI 3.2, 4.2). Large heterogeneity was observed in these studies
Prevalence among age groups in community settings
Based on the overlapping age strata from 23 studies, pool prevalence among children aged less than 6 years was significantly higher than that among adults aged greater than or equal to 18 years (10.6%; 95%CI 5.7, 16.8 vs. 2.8%; 95%CI 1.4, 4.6)
Section: Conclusion
The current CA-MRSA prevalence estimates provide a baseline for future national and international surveillance. The pooled prevalence and identification of characteristics associated with CA-MRSA carriage in the community can inform health authorities to formulate specific control policies on high-risk subgroups. Future studies should explore the heterogeneities in the prevalence of CA-MRSA carriage among subgroups and countries, in order to clarify the predominant transmission mechanism in Asia-Pacific and other regions.
著者Jonathan Wong, Margaret Ip, Arthur Tang, Vivien Wei, Samuel Wong, Steven Riley, Jonathan Michael Read, Kin On Kwok
會議名稱18th International Congress on Infectious Diseases (ICID)
會議地點Bureno Aires

上次更新時間 2018-02-05 於 16:14