Prevalence and Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in Custodial Populations: A Systematic Review.

Methicillin-resistant Staphylococcus aureus (MRSA) in prisons can result in serious morbidity and death. We reviewed rates and risk factors for MRSA infection in custody, searching Medline, EMBASE, and CINAHL databases. Between 1997 and 2015, 17 studies reported MRSA skin and soft tissue infections (SSTIs), with four case reports of MRSA non-SSTI (necrotizing pneumonias, brain abscess, and epiduritis). Significant associations with MRSA SSTI were found: MRSA colonization, previous skin infection, sharing soap or personal items, SSTI presenting as an abscess or furuncle, younger age, non-Caucasian, overweight, communal laundering, infrequent handwashing, lower hygiene score. RECOMMENDATIONS: early identification, isolation, and treatment of skin infections at admission; education on maintaining skin integrity and presenting early with skin infections; increasing hygiene by not sharing items and encouraging handwashing; improved handling and disinfection of communal laundering; influenza vaccination for all prisoners and staff; and population-based longitudinal studies including younger detainees.