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Dysfunctional accessory gene regulator (agr) as a prognostic factor in invasive Staphylococcus aureus infection: a systematic review and meta-analysis
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Dysfunctional accessory gene regulator (agr) as a prognostic factor in invasive Staphylococcus aureus infection: a systematic review and meta-analysis
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Journal Article
Dysfunctional accessory gene regulator (agr) as a prognostic factor in invasive Staphylococcus aureus infection: a systematic review and meta-analysis
2020
Overview
The accessory gene regulator (
agr
) locus of
Staphylococcus aureus
is a quorum-sensing virulence regulator. Although there are many studies concerning the effect of dysfunctional
agr
on the outcomes of
S. aureus
infection, there is no systematic review to date. We systematically searched for clinical studies reporting outcomes of invasive
S. aureus
infections and the proportion of dysfunctional
agr
among their causative strains, and we performed a meta-analysis to obtain estimates of the odds of outcomes of invasive
S. aureus
infection with dysfunctional versus functional
agr
. Of 289 articles identified by our research strategy, 20 studies were meta-analysed for crude analysis of the impact of dysfunctional
agr
on outcomes of invasive
S. aureus
infection. Dysfunctional
agr
was generally associated with unfavourable outcomes (OR 1.32, 95% CI 1.05–1.66), and the impact of dysfunctional
agr
on outcome was more prominent in invasive methicillin-resistant
S. aureus
(MRSA) infections (OR 1.54, CI 1.20–1.97). Nine studies were meta-analysed for the impact of dysfunctional
agr
on the 30-day mortality of invasive
S. aureus
infection. Invasive MRSA infection with dysfunctional
agr
exhibited higher 30-day mortality (OR 1.40, CI 1.03–1.90) than that with functional
agr
. On the other hand, invasive MSSA infection with dysfunctional
agr
exhibited lower 30-day mortality (OR 0.51, CI 0.27–0.95). In the post hoc subgroup analysis by the site of MRSA infection, dysfunctional
agr
was associated with higher 30-day mortality in MRSA pneumonia (OR 2.48, CI 1.17–5.25). The effect of dysfunctional
agr
on the outcome of invasive
S. aureus
infection may vary depending on various conditions, such as oxacillin susceptibility and the site of infection. Dysfunctional
agr
was generally associated with unfavourable clinical outcomes and its effect was prominent in MRSA and pneumonia. Dysfunctional
agr
may be applicable for outcome prediction in cases of invasive MRSA infection with hardly eradicable foci such as pneumonia.
Publisher
Nature Publishing Group UK,Nature Publishing Group
