MRSA colonization and acquisition in the burn unit: A systematic review and meta-analysis

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most commonly encountered bacteria in the burn unit. In order to investigate the magnitude of this challenge, we assessed the prevalence of MRSA colonization on admission and the incidence of MRSA acquisition within burn units. Methods: We searched PubMed and EMBASE for studies reporting MRSA colonization among patients admitted in burn units. Results: We identified 16 articles that fulfilled our inclusion criteria and found an overall pooled prevalence of MRSA colonization upon the first 72 h of admission (colonization on admission) to the burn unit of 4.1% (95% CI: 2.7%–5.7%). MRSA acquisition in studies without a decolonization protocol was 21.2% (95% CI: 13.2%–30.5%) with a statistically significant downward trend over the years. Studies that implemented a decolonization protocol yielded a MRSA acquisition incidence rate of 4.5% (95% CI: 0.9%–10.6%). MRSA acquisition was higher among patients that have had inhalation injury (OR 3.96, 95% CI: 2.51–6.23), flame burns (OR 1.85, 95% CI: 1.25–2.73), or ICU admission (OR 3.12, 95% CI: 2.18–4.47). Conclusion: Our study yielded that among burn victims, MRSA colonization prevalence on admission is not negligible and the risk of becoming MRSA colonized during hospitalization is higher when no decolonization protocols are implemented. Flame burns, admission to ICU, and inhalation injury were found to be associated with MRSA acquisition.