Epidemiology of clinically isolated methicillin-resistant Staphylococcus aureus (MRSA) and its susceptibility to linezolid and vancomycin in Egypt: a systematic review with meta-analysis

Abstract

Background Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes severe morbidity and mortality worldwide. For the establishment of national strategies to combat MRSA infection in each country, accurate and current statistics characterizing the epidemiology of MRSA are essential. The purpose of this study was to determine the prevalence of MRSA among Staphylococcus aureus clinical isolates in Egypt. In addition, we aimed to compare different diagnostic methods for MRSA and determine the pooled resistance rate of linezolid and vancomycin to MRSA. To address this knowledge gap, we conducted a systematic review with meta-analysis. Methods A comprehensive literature search from inception to October 2022 of the following databases was performed: MEDLINE [PubMed], Scopus, Google Scholar, and Web of Science. The review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement. Based on the random effects model, results were reported as proportions with a 95% confidence interval (CI). Analyses of the subgroups were conducted. A sensitivity analysis was conducted to test the robustness of the results. Results A total of sixty-four (64) studies were included in the present meta-analysis, with a total sample size of 7171 subjects. The overall prevalence of MRSA was 63% [95% CI: 55–70]. Fifteen (15) studies used both PCR and cefoxitin disc diffusion for MRSA detection, with a pooled prevalence rate of 67% [95% CI: 54–79] and 67% [95% CI: 55–80], respectively. While nine (9) studies used both PCR and Oxacillin disc diffusion for MRSA detection, the pooled prevalences were 60% [95% CI: 45–75] and 64% [95% CI: 43–84], respectively. Furthermore, MRSA appeared to be less resistant to linezolid than vancomycin, with a pooled resistance rate of 5% [95% CI: 2–8] to linezolid and 9% [95% CI: 6–12] to vancomycin, respectively. Conclusion Our review highlights Egypt's high MRSA prevalence. The cefoxitin disc diffusion test results were found to be consistent with PCR identification of the mecA gene. A prohibition on antibiotic self-medication and efforts to educate healthcare workers and patients about the proper use of antimicrobials may be required to prevent further increases.

Antimicrobial resistance burden pre and post-COVID-19 pandemic with mapping the multidrug resistance in Egypt: a comparative cross-sectional study

“…In the same vein, Helmy et al 24 reported that the MRSA culture results had low resistance rates against tigecycline and linezolid. Furthermore, a meta analysis included 64 studies concluded that resistance of MRSA slightly changed post COVID-19 pandemic, with reserved susceptibility to vancomycin, tigecycline, or linezolid 28 .…”

New Sequence Types of Staphylococcus aureus Strains Isolated from Hospitals and Community Settings in Southern Iran

“…The overall prevalence of clinically isolated MRSA in Egypt is notably high at 63% (17). Variations in MRSA prevalence across different regions of Iran may be due to differences in infection control practices, healthcare conditions, antibiotic prescription practices, selective antibiotic pressure in hospitals, and underlying clinical conditions.…”

Antibiotic Resistance Profiles and MLST Typing of Staphylococcus Aureus Clone Associated with Skin and Soft Tissue Infections in a Hospital of China

“…The results of this study suggest that the use of β-lactam, macrolide, and lincosamide antimicrobial agents should be reduced. Therefore, in the medical environment, we need to use antibiotics carefully, 39 strengthen the monitoring of drug resistance, and choose antibiotics rationally according to the results of drug sensitivity. The dosage of antibiotics should be strictly controlled, and the rotation of drugs and withdrawal period should be strictly implemented.…”