Methicillin-Resistant Staphylococcus aureus Nasal Swab Utilization as a Predictor for Methicillin-Resistant Staphylococcus aureus Skin and Soft Tissue Infections: A Systematic Review and Meta-analysis

Background: Methicillin-resistant Staphylococcus aureus (MRSA) infections are associated with high morbidity and mortality, though isolation on a culture can often be difficult We performed a systematic review and meta-analysis to examine use of MRSA nasal swabs for the prediction of this organism as a cause of skin and soft tissue infection (SSTI). Method: Electronic databases were systematically searched. Selected studies were combined and data extracted and analyzed to calculate diagnostic performance characteristics. Results: Twenty-five studies were included. The overall positive predictive value was 70% and negative predictive value 87%. The positive and negative predictive values were 77% and 87% for a mixed composite of SSTIs, 71% and 91% for purulent infections, 63% and 87% for diabetic foot infections, and 48% and 79% for surgical site infections, respectively. Conclusions: Nasal screening as a predictor for MRSA SSTIs has a high negative predictive value in areas where MRSA prevalence is low.