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JAC Advance Access originally published online on November 6, 2007
Journal of Antimicrobial Chemotherapy 2008 61(1):26-38; doi:10.1093/jac/dkm416
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Systematic review

Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis

Evelina Tacconelli*, Giulia De Angelis, Maria A. Cataldo, Emanuela Pozzi and Roberto Cauda

Department of Infectious Diseases, Catholic University, Rome, Italy

Received 23 July 2007; returned 4 October 2007; revised 23 August 2007; accepted 8 October 2007

* Corresponding author. Tel: +39-06-30155527; Fax: +39-06-3054519; E-mail: etacconelli{at}rm.unicatt.it

Background: Current evidence does not provide a clear definition of the association between methicillin-resistant Staphylococcus aureus (MRSA) isolation and previous antibiotic use. A systematic review was performed to determine whether antibiotic exposure is a risk factor for the isolation of MRSA.

Methods: MEDLINE and EMBASE databases were searched to identify studies published between 1976 and 2007 on the role of antibiotics as a risk factor for MRSA isolation in adult patients. The outcome of interest was MRSA isolation. Summary statistics were risk ratios (RR) comparing MRSA-positive patients to those without S. aureus isolation or with methicillin-susceptible S. aureus isolation.

Results: Seventy-six studies, including a total of 24 230 patients, met the inclusion criteria. Antibiotic exposure was determined in the 126 ± 184 (mean ± SD) days preceding MRSA isolation. The risk of acquiring MRSA was increased by 1.8-fold [95% confidence interval (CI), 1.7–1.9; P < 0.001] in patients who had taken antibiotics. The RR for single classes of antibiotics was 3 (95% CI, 2.5–3.5) for quinolones, 2.9 (95% CI, 2.4–3.5) for glycopeptides, 2.2 (95% CI, 1.7–2.9) for cephalosporins and 1.9 (95% CI, 1.7–2.2) for other β-lactams. Significant heterogeneity was detected among studies. A regression analysis revealed that the heterogeneity was linked to the length of time in which antibiotic exposure was detected before MRSA isolation (more or less than 180 days).

Conclusions: This meta-analysis shows a clear association between exposure to antibiotics and MRSA isolation. This information may be useful for researchers in designing future studies and for policy decision-making on the appropriate management of antibiotic therapies.

Keywords: antibiotic resistance , Gram-positive , antimicrobials


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