Risks for Staphylococcus aureus Colonization in Psoriasis Patients: A Systematic Review and Meta-Analysis

Abstract

Evidence on whether psoriasis patients have a higher risk for staphylococcal colonization than healthy controls remained controversial. To synthesize the current literature, we performed a systematic review on prevalence and relative risk (RR) of S. aureus colonization in psoriasis patients. We modified the QUADAS-2 instrument to assess the reporting quality of individual studies and applied random-effects models in meta-analysis. Overall, we identified 21 eligible studies, of which 15 enrolled one or more comparison groups. The pooled prevalence of staphylococcal colonization in psoriasis patients was 35.3% (95% confidence interval [CI]: 25.0%, 45.6%) on lesional skin and 39.2% (95%CI: 33.7%, 44.8%) in the nares. Psoriasis patients were 4.5-times more likely to be colonized by S. aureus than healthy controls were on the skin (RR: 5.54; 95% CI: 3.21,9.57) and in the nares (RR: 1.60; 95%CI: 1.11, 2.32). Cutaneous and nasal colonization by methicillin-resistant strains (MRSA) also appeared higher in psoriasis patients (pooled prevalence: 8.6%) than in healthy subjects (2.6%) yet the difference was not statistically significant (P: 0.740). In contrast, despite of a similar risk for nasal staphylococcal colonization (RR: 0.67, 95%CI: 0.38, 1.18), psoriasis patients were less likely to carry S. aureus on lesional skin than atopic patients (RR: 0.64; 95%CI: 0.40, 1.02). In summarizing the current literature, we found that psoriasis patients were at an increased risk for staphylococcal colonization as compared to healthy individuals. Prospective studies on how bacterial loads correlate with disease activity can guide the clinical management of bacterial colonization while preventing the emergence of drug-resistant strains.

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