Background: Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant challenge in ICU settings, increasing morbidity, mortality, and healthcare costs. This study systematically reviews and conducts a meta-analysis on the effectiveness of decolonization strategies using chlorhexidine gluconate (CHG) and mupirocin in reducing MRSA infections in ICUs.

Methods: A comprehensive search of Medline and PubMed from 2013 to April 2024 identified studies evaluating the effects of CHG, mupirocin, or their combination for decolonization. Eleven studies met the inclusion criteria for the meta-analysis. Data extraction focused on risk ratios, incidence rates, and true positive and negative outcomes, with standardized calculations across studies.

Results: The random-effects model indicated a significant reduction in MRSA colonization and infection rates (estimate = -0.5284, p = 0.0002), with a high degree of heterogeneity (I² = 96.69%). The pooled relative risk was 0.59 [0.45, 0.78], suggesting a 41% reduction in MRSA risk. The mixed-effects model identified significant residual heterogeneity (I² = 95.44%) and a borderline significant impact of decolonization agents (QM p = 0.0503). Subgroup analyses showed that CHG alone (RR = 0.40 [0.23, 0.69]) and the combination of CHG and mupirocin (RR = 0.76 [0.62, 0.93]) significantly reduced MRSA rates, while mupirocin alone did not achieve statistical significance (RR = 0.80 [0.62, 1.03]).

Conclusions: Decolonization interventions, particularly those involving chlorhexidine and its combination with mupirocin, are effective in reducing MRSA colonization and infection rates in ICUs. The findings highlight the need for tailored decolonization strategies in clinical practice and underscore the importance of further research to optimize MRSA prevention and control measures.