Predictive Value of MRSA Nares Colonization in Diabetic Foot Infections: A Systematic Review and Bivariate Random Effects Meta-Analysis

Department

Podiatry

Document Type

Article

Publication Title

The Journal of Foot and Ankle Surgery

Abstract

The primary objective of this study was to assess the negative predictive value of MRSA nasal swabs in methicillin-resistant Staphylococcus aureus diabetic foot infections.

MEDLINE and Cochrane Library was searched from inception to May 1, 2020. The following search string was used: (methicillin-resistant Staphylococcus aureus OR MRSA) AND (nasal OR nares) AND (diabetic OR foot OR diabetic foot infections). All studies that contained data comparing MRSA nasal swab positivity to wound cultures from diabetic foot infections and met the inclusion criteria were included. Among the 86 relevant studies, 6 studies with 8,706 diabetic patients were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline extension for Diagnostic Test Accuracy (DTA) reviews was followed. The primary meta-analysis outcomes were the negative and positive predictive values of MRSA nasal swabs for MRSA diabetic foot infections. The pooled specificity and pooled sensitivity were determined by generating hierarchical summary receiver characteristic operating curves. In the bivariate meta-analysis, involving the six studies, pooled sensitivity and specificity was 41.7% (95% CI=32.9, 51) and 94.1% (95% CI=89.5, 96.8), respectively. In low-moderate MRSA prevalence levels (< 15%), negative predictive value of MRSA nasal swab was > 90% and positive predictive value was < 55%.

This meta-analysis suggests that in patients with diabetic foot infections, the nasal swab MRSA screen has a poor positive predictive value but an excellent negative predictive value in regions of low to moderate prevalence of MRSA diabetic foot infections.

DOI

10.1053/j.jfas.2022.06.006

Publication Date

6-18-2022

PubMed ID

36922315

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