Indexed on: 21 Jan '20Published on: 17 Jan '20Published in: International Journal of Infectious Diseases
Many studies have reported MRSA transmission from patients infected or colonised with MRSA to their household contacts, but the importance of household transmission for persistence of MRSA in the community and reintroduction into healthcare settings is not well understood. In this review, we evaluated evidence on (i) MRSA prevalence, (ii) MRSA contact positivity, and (iii) MRSA carriage duration in household contacts of MRSA-positive individuals. We searched MEDLINE and Embase databases from 1 January 1960 to 15 November 2019 for studies with data on these outcomes. Random-effects model meta-analysis was conducted with included studies to calculate pool prevalence ratios. We included 22 relevant articles. In a meta-analysis, the pooled prevalence of MRSA among culture positive MRSA household contacts was 25.0% (95% CI 20.0%-30.0%). A subset of studies with adequate comparison groups reported higher colonisation prevalence among household contacts of MRSA-positive patients compared with household contacts of MRSA-negative individuals. MRSA contact positivity varied between 19.0% and 33.0%, but variation in sampling frequency and follow-up duration made between-study comparisons challenging. Substantial MRSA transmission occurs in household settings. Improved understanding of household transmission dynamics, and the relationship between transmission in healthcare and household settings, will be critical to inform improved strategies to control MRSA. Copyright © 2020. Published by Elsevier Ltd.