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Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of infection within neonatal intensive care units.Very preterm and very-low birth weight infants are at an increased risk for MRSA colonization.Infection prevention efforts should target these high-risk infants.Methicillin-resistant Staphylococcus aureus (MRSA) causes a significant burden of illness in neonatal intensive care units (NICUs) worldwide. Identifying infants colonized with MRSA has become an important infection control strategy to interrupt nosocomial transmission.Assess risk factors for MRSA colonization in NICUs via a systematic review and meta-analysis.MEDLINE, Embase, Web of Science, and The Cochrane Library databases were searched from inception through September 2015.Studies reporting risk factors for MRSA colonization using noncolonized controls in subspecialty level III or IV NICUs were included.Two authors independently extracted data on MRSA colonization risk factors, study design, and MRSA screening methodology.Eleven articles were included in the systematic review, with 10 articles analyzed via meta-analysis. MRSA colonization was associated with gestational age <32 weeks (odds ratio [OR], 2.67; 95% confidence interval [CI], 1.35-5.27; P = .01) and birth weight <1,500 g (OR, 2.63; 95% CI, 1.25-5.55; P = .01). Infant sex (P = .21), race (P = .06), inborn status (P = .09), and delivery type (P = .24) were not significantly associated with colonization.Very preterm and very-low birth weight infants were identified as having an increased risk for MRSA colonization on meta-analysis. Multifaceted infection prevention strategies should target these high-risk infants to reduce MRSA colonization rates in NICUs.