Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Chinese Children: A Prevalence Meta-Analysis and Review of Influencing Factors

OBJECTIVE: To determine the pooled prevalence and review the influencing factors of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in Chinese children. METHODS: Articles published between January 2005 and October 2015 that studied prevalence or influencing factors of MRSA nasal colonization in Chinese children were retrieved from Chinese Biomedical Literature database (CBM), China National Knowledge Infrastructure (CNKI) database, Chinese VIP database, Chinese Wanfang database, Medline database and Ovid database. Prevalence and influencing factors were analyzed by STATA 13.1. RESULTS: Thirteen articles were included. The overall prevalence of MRSA nasal colonization was 4.4% (95% confidence interval [CI]: 0.027–0.062). With an MRSA prevalence of 3.9% (95% CI: 0.018–0.061) in healthy children and 5.8% (95% CI: 0.025–0.092) in children with underlying medical conditions. Children recruited in the hospitals presented MRSA prevalence of 6.4% (95% CI: 0.037–0.091), which was higher than those recruited in the communities [2.7% (95% CI: 0.012–0.043)]. A number of influencing factors for MRSA nasal colonization were noted in three eligible studies: gender (male vs female; OR: 0.67; 95% CI: 0.55–0.82), younger age (OR: 2.98; 95% CI: 1.31–6.96 and OR: 1.56; 95% CI: 1.21–2.00), attending day care centers (OR: 2.97; 95% CI: 1.28–6.76), having infectious diseases (OR: 2.31; 95% CI: 1.10–4.52), using antibiotics (OR: 2.77; 95% CI: 1.45–5.05), residing in northern Taiwan (OR: 1.41; 95% CI: 1.15–1.71), passive smoking (OR: 1.30; 95% CI: 1.02–1.63), and pneumococcal vaccination (OR: 1.22; 95% CI: 1.01–1.48). CONCLUSIONS: Children could act as reservoirs of MRSA transmissions. Hospitals remained the most frequent microorganism-circulated settings. More MRSA infection control strategies are required to prevent the dissemination among children.