Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) carriage among rehabilitation facilities patients at admission: a systematic review and meta-analysis.

OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) carriage at admission to rehabilitation facilities may favour onward transmission, infectious complications, and poorer rehabilitation outcomes. Although individual observational studies have explored associated risk factors, no systematic review and meta-analysis has specifically addressed this issue in rehabilitation settings. METHODS: We performed a systematic review and meta-analysis of observational studies evaluating risk factors for MRSA carriage at admission to rehabilitation facilities. MEDLINE, PubMed, and Embase were searched from inception to 4 February 2025. Studies were eligible if they enrolled patients screened for MRSA at admission and reported quantitative data on associated risk factors. Adjusted effect estimates were preferentially pooled using random-effects models when at least two sufficiently comparable studies were available, whereas crude estimates were analysed separately when adjusted data were unavailable. Because of the small number of included studies and the limited number of studies per comparison, meta-regression by country, calendar period, or screening strategy was not feasible; therefore, pooled estimates were interpreted as exploratory. RESULTS: Six studies were included in both the qualitative and quantitative synthesis. Exploratory adjusted analyses suggested associations between MRSA screening positivity at admission and previous hospitalization, male sex, and previous MRSA carriage/history. Previous MRSA carriage/history showed the largest effect estimate, although heterogeneity was substantial and definitions were not uniform across studies. Crude analyses were reported separately and were considered hypothesis-generating because of potential confounding and heterogeneity in screening protocols. CONCLUSIONS: Available evidence suggests that previous MRSA carriage/history and recent healthcare exposure may help identify patients with increased likelihood of MRSA screening positivity at admission to rehabilitation facilities. However, these findings should be interpreted as exploratory because of heterogeneity in study period, country, screening protocols, and definitions of previous MRSA carriage.