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Prevalence of Methicillin-Resistant Staphylococcus aureus carriage among Healthcare Workers in South Asia in non-outbreak settings: a systematic review and meta-analysis

      Highlights

      • Methicillin-Resistant Staphylococcus aureus (MRSA) causes a fatal and invasive form of the disease
      • Healthcare Workers(HCWs) are at greater risk of colonization with MRSA
      • HCWs cause transmission of MRSA within a hospital setting
      • Prevalence of MRSA carriage among HCWs is slightly higher in South Asia than in European and American Nation
      • Our study summarized the overall MRSA carriage rate of 9.23% (95%CI; 6.50%, 12.35%) among HCWs in SAARC nations, with nurses having higher odds of getting infected

      Abstract

      Background

      This study aimed to estimate the pooled prevalence and sub-group-specific prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) carrier rate among Healthcare Workers (HCWs) in South Asia.

      Methodology

      We considered prospective and cross-sectional studies published in the English language with participants ≥ 50 by searching different electronic databases to locate the relevant articles that reported the epidemiology of MRSA. The participants were healthy South Asian nationality HCWs (asymptomatic for any infectious disease) of any age and gender with a definitive diagnosis of MRSA carriage. The result was synthesized for the pooled prevalence of MRSA carriers among HCWs using 95% confidence interval (CI) with DerSimonian and Laird random-effects models.

      Results

      The pooled prevalence of MRSA carriage among HCWs was 9.23% (95%CI; 6.50%, 12.35%) with a range from 0.67% to 36.06%. The prevalence in India, Nepal, Pakistan, Sri Lanka, and Bangladesh was 5.65% (95%CI; 3.65%, 8.03%), 8.83% (95%CI; 6.77%, 11.11%), 17.20% (95%CI; 10.70%, 24.85%), 22.56% (95%CI; 4.93%, 47.83%) and 4.93% (95%CI; 1.88%, 9.20%) respectively. The pooled prevalence of MRSA carriage among nurses and doctors was 8.90% (95%CI; 6.00%, 12.24%) and 6.53% (95%CI; 3.63%, 10.06%) respectively.

      Conclusion

      The findings from our study suggests that if the propagation of MRSA continues, then it can lead to a situation of an outbreak. Hence, proper preventive measures are to be adopted to prevent this outbreak.

      Graphical Abstract

      Keywords

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      References

        • Barber M.
        Methicillin-resistant staphylococci.
        Journal of clinical pathology. 1961; 14: 385-393
        • Benner EJ
        • Kayser FH.
        Growing clinical significance of methcillin-resistant Staphylococcus aureus.
        Lancet (London, England). 1968; 2: 741-744
      1. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004.
        American journal of infection control. 2004; 32: 470-485
        • Tacconelli E
        • De Angelis G
        • Cataldo MA
        • Pozzi E
        • Cauda R.
        Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis.
        J Antimicrob Chemother [Internet]. 2008; 61 (Jan [cited 2022 May 22]Available from: https://pubmed.ncbi.nlm.nih.gov/17986491/)
        • Witte W
        • Kresken M
        • Braulke C
        • Cuny C
        Increasing incidence and widespread dissemination of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals in central Europe, with special reference to German hospitals.
        Clin Microbiol Infect. 1997; 3: 414-422
        • Klevens RM
        • Morrison MA
        • Nadle J
        • Petit S
        • Gershman K
        • Ray S
        • et al.
        Invasive methicillin-resistant Staphylococcus aureus infections in the United States.
        Jama. 2007; 298: 1763-1771
        • Wisplinghoff H
        • Bischoff T
        • Tallent SM
        • Seifert H
        • Wenzel RP
        • Edmond MB.
        Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. 39. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 2004: 309-317
        • Boyce JM.
        Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology, and preventive measures.
        Infection control and hospital epidemiology. 1992; 13: 725-737
        • Klevens RM
        • Edwards JR
        • Tenover FC
        • McDonald LC
        • Horan T
        • Gaynes R.
        Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. 42. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 2006: 389-391
        • Cosgrove SE
        • Sakoulas G
        • Perencevich EN
        • Schwaber MJ
        • Karchmer AW
        • Carmeli Y.
        Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. 36. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 2003: 53-59
        • Uematsu H
        • Yamashita K
        • Kunisawa S
        • Fushimi K
        • Imanaka Y.
        Estimating the disease burden of methicillin-resistant Staphylococcus aureus in Japan: retrospective database study of Japanese hospitals.
        PLoS One. 2017; 12 (Jun 27)e0179767
        • Nickerson EK
        • Wuthiekanun V
        • Day NP
        • Chaowagul W
        • Peacock SJ.
        Methicillin-resistant <em>Staphylococcus aureus</em>in rural Asia.
        The Lancet Infectious Diseases. 2006; 6 (10.1111/j.1469-0691.1997.tb00277.x): 70-71
        • Safdar N
        • Bradley EA.
        The Risk of Infection after Nasal Colonization with Staphylococcus Aureus.
        Am J Med. 2008 Apr 1; 121: 310-315
        • Borenstein M
        • Hedges LV.
        • Higgins JPT
        • Rothstein HR
        A basic introduction to fixed-effect and random-effects models for meta-analysis.
        Res Synth Methods [Internet]. 2010; 1 (Apr [cited 2022 May 23]Available from: https://pubmed.ncbi.nlm.nih.gov/26061376/): 97-111
        • Freeman MF
        • Tukey JW.
        Transformations related to the angular and the square root.
        The Annals of Mathematical Statistics. 1950; (Dec 1): 607-611
      2. Antibiotic resistance in the European Union. [cited 2022 May 23]; Available from: http://www.ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/database/Pages/database.aspx

        • Cirkovic I
        • Stepanovic S
        • Skov R
        • Trajkovic J
        • Grgurevic A
        • Larsen AR.
        Carriage and genetic diversity of methicillin-resistant Staphylococcus aureus among patients and healthcare workers in a Serbian university hospital.
        PLoS One. 2015; 10e0127347
        • Acton DS
        • Plat-Sinnige MJT
        • van Wamel W
        • de Groot N
        • van Belkum A.
        Intestinal carriage of Staphylococcus aureus: how does its frequency compare with that of nasal carriage and what is its clinical impact?.
        Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2009; 28 (Feb): 115-127
        • Albrich WC
        • Harbarth S.
        Health-care workers: source, vector, or victim of MRSA?.
        The Lancet Infectious diseases. 2008; 8: 289-301
        • Dow G
        • Field D
        • Mancuso M
        • Allard J.
        Decolonization of methicillin-resistant Staphylococcus aureus during routine hospital care: Efficacy and long-term follow-up.
        Can J Infect Dis Med Microbiol. 2010; 21: 38-44
        • Ayliffe G.
        The progressive intercontinental spread of methicillin-resistant Staphylococcus aureus.
        Clinical Infectious Diseases. 1997; 24: S74-SS9
        • Khanal R
        • Sah P
        • Lamichhane P
        • Lamsal A
        • Upadhaya S
        • Pahwa VK.
        Nasal carriage of methicillin resistant Staphylococcus aureus among health care workers at a tertiary care hospital in Western Nepal.
        Antimicrobial resistance and infection control. 2015; 4: 1-5
        • Vonberg R-P
        • Stamm-Balderjahn S
        • Hansen S
        • Zuschneid I
        • Ruden H
        • Behnke M
        • et al.
        How often do asymptomatic healthcare workers cause methicillin-resistant Staphylococcus aureus outbreaks? A systematic evaluation.
        Infect Control Hosp Epidemiol. 2006; 27 (Oct): 1123-1127
        • Hawkins G
        • Stewart S
        • Blatchford O
        • Reilly J.
        Should healthcare workers be screened routinely for meticillin-resistant Staphylococcus aureus? A review of the evidence.
        J Hosp Infect. 2011; 77 (Apr): 285-289
        • Dulon M
        • Haamann F
        • Nienhaus A.
        Involvement of occupational physicians in the management of MRSA-colonised healthcare workers in Germany - a survey.
        J Occup Med Toxicol. 2013; 8 (May): 16
        • Lindsay JA.
        Hospital-associated MRSA and antibiotic resistance—What have we learned from genomics?.
        International Journal of Medical Microbiology. 2013; 303: 318-323
        • Egger M
        • Smith GD
        • Schneider M
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ [Internet]. 1997; 315 (Sep 13 [cited 2022 May 27]Available from: https://www.bmj.com/content/315/7109/629): 629-634
      3. World Health Organization Global Action Plan on Antimicrobial Resistance. [Accessed August 7, 2017 ]. Available from: https://www.who.int/antimicrobial-resistance/global-action-plan/en/

        • Moher D
        • Altman DG
        • Liberati A
        • Tetzlaff J.
        PRISMA statement.
        Epidemiology (Cambridge, Mass). 2011; 22: 128
        • The Joanna Briggs Institute
        Joanna Briggs Institute Reviewers’.
        Manual. Edition, 2014 (2014)
        • Viera AJ
        • Garrett JM.
        Understanding interobserver agreement: the kappa statistic.
        Fam Med. 2005; 37: 360-363
        • Cochran GW.
        The combination of estimates from different experiments.
        Biometrics. 1954; 10: 101-129
        • Higgins JP
        • Thompson SG.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Agarwal L
        • Singh AK
        • Sengupta C
        • Agarwal A.
        Nasal carriage of Methicillin- and Mupirocin-resistant S. aureus among health care workers in a tertiary care hospital.
        J Res Pharm Pract [Internet]. 2015; 4: 182-186
        • Akter R
        • Paul S
        • Naher A
        • Rahman M
        • Sultana S
        • Sarkar D.
        Nasal Carriage of Methicillin Resistant Staphylococcus aureus Among Health Care Workers At Tertiary Care Hospital In Dhaka.
        Bangladesh Journal of Medical Microbiology. 2017; 11 (Jul 25): 17-19
        • Farzana K
        • Rashid Z
        • Akhtar N
        • Sattar A
        • Khan JA
        • Nasir B.
        Nasal carriage of staphylococci in health care workers: antimicrobial susceptibility profile.
        Pak J Pharm Sci. 2008 Jul; 21: 290-294
        • Hanif E
        • Hassan SA.
        Evaluation of antibiotic resistance pattern in clinical isolates of Staphylococcus aureus.
        Pak J Pharm Sci. 2019 Jul; 32 (4(Supplementary)): 1749-1753
        • Jayaweera JAAS
        • Pilapitiya S
        • Kumbukgolla W
        The relationship between the exposure to healthcare settings and colonization with methicillin-resistant Staphylococcus aureus among medical students.
        Germs. 2020; 10: 34
        • Khatri S
        • Pant ND
        • Bhandari R
        • Shrestha KL
        • Shrestha CD
        • Adhikari N
        • et al.
        Nasal Carriage Rate of Methicillin Resistant Staphylococcus aureus among Health Care Workers at a Tertiary Care Hospital in Kathmandu, Nepal.
        J Nepal Health Res Counc. 2017 Jan; 15: 26-30
      4. Kogekar SP, Jain K, Kumari P, Chavan N, Peshattiwar P, Rajput MS. High level of MRSA colonization in health care worker: alarm to implement health care policy. 2015;

        • Mahalingam U
        • Thirunavukarasu K
        • Murugananthan K.
        Methicillin resistant Staphylococcus aureus among nurses in a tertiary care hospital in northern Sri Lanka.
        Ceylon Med J. 2014; 59
        • Malini J
        • Harle SA
        • Padmavathy M
        • Umapathy BL
        • Navaneeth B V
        • Keerthi Mannan J
        • et al.
        Methicillin-resistant Staphylococcus aureus Carriage among the Health Care Workers in a Tertiary Care Hospital.
        J Clin Diagnostic Res. 2012; 6
        • Mathanraj S
        • Sujatha S
        • Sivasangeetha K
        • Parija SC.
        Screening for methicillin-resistant Staphylococcus aureus carriers among patients and health care workers of a tertiary care hospital in south India.
        Indian J Med Microbiol. 2009; 27: 62-64
        • Mukhiya RK
        • Shrestha A
        • Rai SK
        • Panta K
        • Singh RN
        • Rai G
        • et al.
        Prevalence of methicillin-resistant Staphylococcus aureus in hospitals of Kathmandu valley.
        Nepal J Sci Technol. 2012; 13: 185-190
        • T L
        • Bhat AK
        • H MH
        • Mukhopadyay C
        • Devi ES
        • Nayak BS
        METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS CARRIAGE AMONG HEALTH-CARE PROFESSIONALS OF A TERTIARY CARE HOSPITAL.
        Asian J Pharm Clin Res [Internet]. 2018; 11 (Mar 1Available from: https://innovareacademics.in/journals/index.php/ajpcr/article/view/23151): 346-349
        • Neupane R
        • Bhatt N
        • Poudyal A
        • Sharma A.
        Methicillin-Resistant Staphylococcus aureus Nasal Carriers among Laboratory Technical Staff of Tertiary Hospital in Eastern Nepal.
        Kathmandu Univ Med J. 2020; 69: 3-8
        • Radhakrishna M
        • D'Souza M
        • Kotigadde S
        • Saralaya V
        • Kotian S
        Prevalence of methicillin resistant Staphylococcus aureus carriage amongst health care workers of critical care units in Kasturba Medical College Hospital, Mangalore, India.
        J Clin diagnostic Res JCDR. 2013; 7: 2697
        • Renushri B
        • Saha A
        • Nagaraj E
        • Rama N
        • Krishnamurthy V
        • Chandrashekar S.
        Screening for methicillin-resistant Staphylococcus aureus carriers among individuals exposed and not exposed to the hospital environment and their antimicrobial sensitivity pattern.
        Ann Trop Med Public Heal [Internet]. 2014; 7 (Jan 1): 19-24
        • Rongpharpi SR
        • Hazarika NK
        • Kalita H.
        The prevalence of nasal carriage of Staphylococcus aureus among healthcare workers at a tertiary care hospital in Assam with special reference to MRSA.
        J Clin diagnostic Res JCDR. 2013; 7: 257
        • Rukan M
        • Jamil H
        • Bokhari HA
        • Khattak AA
        • Khan AN
        • Ullah Z
        • Hussain S
        • Syed MA.
        Nasal carriage of highly resistant methicillin resistant Staphylococcus aureus (MRSA) strains by hospital staff in Hazara region of Pakistan. JPMA.
        The Journal of the Pakistan Medical Association. 2021; 71 (Jan 11 (A)): 47-50
        • Rutvi V.
        Nasal carriage rate of methicillin resistant Staphylococcus aureus (MRSA) among Civil Hospital health care workers.
        Int J Med Public Heal. 2016; 6: 180-183
        • Salman MK
        • Ashraf MS
        • Iftikhar S
        • Baig MAR
        Frequency of nasal carriage of Staphylococcus aureus among health care workers at a Tertiary Care Hospital.
        Pakistan J Med Sci. 2018; 34: 1181
        • Shah P
        • Dhungel B
        • Bastola A
        • Banjara MR
        • Rijal KR
        • Ghimire P.
        Methicillin Resistant Staphylococcus aureus in Health Care Workers of a Tertiary Care Infectious Disease Hospital in Nepal.
        Tribhuvan University Journal of Microbiology. 2020; 7 (Dec 26): 19-30
        • Sharma BK
        • Regmi SM
        • Sharma K
        • Reddy KR
        • Adhikari S.
        Methicillin Resistant Staphylococcus aureus Contamination of Hands and Mobile Phones of Health Care Workers in a Health Care Setting: A Silent Threat.
        J Gandaki Med Coll. 2019; 12: 32-39
        • Sharma S
        • Pal S
        • Negi V
        • Juyal D
        • Sharma M
        • Prakash R.
        Staphylococcus aureus including MRSA nasal carriage among hospital exposed and unexposed medical students.
        Journal of Family Medicine and Primary Care. 2020; 9 (Sep): 4936
        • Shoaib NF
        • ul Ain Q
        • Iqbal K
        • Asif M.
        Effect of ablution on Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonisation in healthcare workers.
        JPMA. The Journal of the Pakistan Medical Association. 2021; 71 (May 1): 1472-1475
        • Shreyas K
        • Radhakrishna M
        • Hegde A
        • Rao P.
        Is acquisition of methicillin-resistant Staphylococcus aureus—An occupational hazard for medical students in India?.
        Asian J Pharm Clin Res. 2017; 10: 141
        • Singh S
        • Malhotra R
        • Grover P
        • Bansal R
        • Galhotra S
        • Kaur R
        • et al.
        Antimicrobial resistance profile of methicillin-resistant Staphylococcus aureus colonizing the anterior nares of health-care workers and outpatients attending the remotely located tertiary care hospital of North India.
        J Lab Physicians. 2017; 9: 317
        • Singh N
        • Mohanty S
        • Panda SS
        • Sahoo S
        • Pattnaik D
        • Jena J
        Methicillin resistant Staphylococcus aureus (MRSA) carriage among health care workers in a tertiary care hospital in Bhubaneswar.
        Int J Community Med Public Heal Vol 5. 2018; (No 8 August 2018DO - 1018203/2394-6040.ijcmph20182970 [Internet]Jul 23)
        • Srivastava S
        • Dubey S
        • Srivastava N.
        Nasal carriage of methicillin-resistant Staphylococcus aureus among health-care workers at a tertiary care hospital in Northern India.
        Int J Med Sci Public Health. 2019; 8 ([cited December 01, 2020]): 827-832
        • Tariq A.
        Carrier Status of Methicillin-Resistant Staphylococcus aureus (MRSA).
        J Rawalpindi Med Coll. 2017; 21: 244-247
        • Theagrajan A
        • Mahadevaiah S
        • Umamaheshwari S.
        Screening health care personnel for detection of methicillin resistant of Staphylococcus aureus carrier state at a tertiory care hospital in Mysore.
        IJPSI. 2013; 2: 12-15
        • Thilakavathy P
        • Vijaykumar GS
        • Ramesh A
        • Janagond AB
        • Rajendran T
        • Jeremiah SS
        • et al.
        Methicillin-resistant Staphylococcus aureus Nasal Carriage Among Health-care Workers: Decolonization and Follow-up Study Conducted in a Tertiary Care Hospital.
        J Hum Heal. 2015; 1: 16
        • Vinodhkumaradithyaa A
        • Uma A
        • Shirivasan M
        • Ananthalakshmi I
        • Nallasivam P
        • Thirumalaikolundusubramanian P.
        Nasal carriage of methicillin-resistant Staphylococcus aureus among surgical unit staff.
        Jpn J Infect Dis. 2009; 62 (May): 228-229
        • Ziaullah Izhar M
        • Malik A
        • Mahmud TH
        • Khan NZ
        • Iqbal Z
        • et al.
        Prevalence of nasal carriage of Methicillin Resistant Staphylococcus aureus (MRSA) in hospital personnel.
        in: Proceeding Shaikh Zayed Postgr Med Inst [Internet]. 15. 2022: 29-33 (Available from: http://www.pakmedinet.com/8530)
        • Dulon M
        • Peters C
        • Schablon A
        • Nienhaus A.
        MRSA carriage among healthcare workers in non-outbreak settings in Europe and the United States: a systematic review.
        BMC Infectious Diseases. 2014; 14: 363
        • Mathew P
        • Ranjalkar J
        • Chandy SJ.
        Challenges in Implementing Antimicrobial Stewardship Programmes at Secondary Level Hospitals in India: An Exploratory Study [Internet].
        Frontiers in Public Health. 2020; 8: 542
      5. Butler R, Monsalve M, Thomas GW, Herman T, Segre AM, Polgreen PM, Suneja M. Estimating time physicians and other health care workers spend with patients in an intensive care unit using a sensor network. The American journal of medicine. 2018 Aug 1;131(8):972-e9.

        • Vonberg R-P
        • Stamm-Balderjahn S
        • Hansen S
        • Zuschneid I
        • Rüden H
        • Behnke M
        • et al.
        How Often Do Asymptomatic Healthcare Workers Cause Methicillin-Resistant Staphylococcus aureus Outbreaks? A Systematic Evaluation.
        Infection Control & Hospital Epidemiology. 27. Cambridge University Press, 2006: 1123-1127
        • Cafini F
        • Nguyen LTT
        • Higashide M
        • Román F
        • Prieto J
        • Morikawa K.
        Horizontal gene transmission of the cfr gene to MRSA and Enterococcus: role of Staphylococcus epidermidis as a reservoir and alternative pathway for the spread of linezolid resistance.
        J Antimicrob Chemother [Internet]. 2016; 71 (Mar 1): 587-592
        • McConeghy KW
        • Mikolich DJ
        • LaPlante KL.
        Agents for the decolonization of methicillin-resistant Staphylococcus aureus.
        Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2009 Mar; 29: 263-280
      6. Graham DW, Collignon Peter. ‘The next pandemic might be worse’: Scientists are already fighting the next global superbug. The Independent. June 2020. Available from: https://www.independent.co.uk/climate-change/news/coronavirus-antibiotics-superbug-environm ent-virus-disease-next-pandemic-a9556671.html

        • Kourtis AP
        • Hatfield K
        • Baggs J
        • Mu Y
        • See I
        • Epson E
        • Nadle J
        • Kainer MA
        • Dumyati G
        • Petit S
        • Ray SM.
        Vital signs: epidemiology and recent trends in methicillin-resistant and in methicillin-susceptible Staphylococcus aureus bloodstream infections—United States.
        Morbidity and Mortality Weekly Report. 2019; 68 (Mar 8): 214