Nasopharyngeal Methicillin-Resistant Staphylococcus aureus Carriage and Risk of Percutaneous Endoscopic Gastrostomy-Related Infection: A Systematic Review and Meta-Analysis

Introduction: Enteral feeding via percutaneous endoscopic gastrostomy (PEG) is commonly used for patients requiring long-term nutritional support. However, PEG insertion carries a risk of infection, including methicillin-resistant Staphylococcus aureus (MRSA) peristomal infections. This systematic review and meta-analysis aimed to evaluate the association between MRSA colonization and the risk of PEG-related infections. METHODS: A systematic search was conducted in four major databases - Embase, MEDLINE, Cochrane, and Scopus - focusing on studies reporting MRSA colonization and PEG-related infections. Data were analyzed using RevMan v5.3. Odds ratios (OR) were calculated for dichotomous outcomes using a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the I2 statistic. RESULTS: Five studies encompassing 286 patients were included in the meta-analysis. Among them, 77 patients were nasopharyngeal MRSA-positive, and 209 were MRSA-negative. MRSA colonization was significantly associated with an increased risk of PEG-related peristomal infection (OR: 24.31; 95% CI: 5.20-113.65; p < 0.0001). Moderate heterogeneity was observed among studies (I2 = 69%, p = 0.01), likely reflecting differences in study design and infection definition; however, the overall association remained statistically significant. CONCLUSION: Nasopharyngeal MRSA colonization is strongly associated with a higher risk of PEG-site infection. These findings highlight the importance of MRSA screening and consideration of colonization status prior to PEG tube insertion. Enhanced infection control strategies should be implemented in MRSA-positive patients to reduce the risk of complications. However, given the limited number of included studies (n = 5; 286 patients), these conclusions should be interpreted with caution. Larger, well-designed studies are needed to validate these associations and identify the most effective preventive measures for MRSA-colonized individuals undergoing PEG placement. .