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Meta-Analysis
. 2019 Mar:16:17-27.
doi: 10.1016/j.jgar.2018.08.014. Epub 2018 Aug 23.

Determinants of methicillin-resistant Staphylococcus aureus (MRSA) prevalence in the Asia-Pacific region: A systematic review and meta-analysis

Wey Wen Lim  1 , Peng Wu  2 , Helen S Bond  1 , Jessica Y Wong  1 , Kaiwen Ni  1 , Wing Hong Seto  1 , Mark Jit  3 , Benjamin J Cowling  1
Affiliations
Meta-Analysis

Determinants of methicillin-resistant Staphylococcus aureus (MRSA) prevalence in the Asia-Pacific region: A systematic review and meta-analysis

Wey Wen Lim et al. J Glob Antimicrob Resist. 2019 Mar.

Abstract

Objectives: Published literature on methicillin-resistant Staphylococcus aureus (MRSA) in the Asia-Pacific region was reviewed to document the prevalence of MRSA in the region and to examine the impact of variability in study design on the reported MRSA prevalence data.

Methods: This review included studies reporting MRSA prevalence between 2000 and 2016. Studies were excluded if they did not contain complete information on antimicrobial susceptibility testing (AST) methods. Primary outcomes were the proportion of MRSA among S. aureus isolates (resistance proportion) or among individual samples (prevalence).

Results: A total of 229 studies in 19 countries/territories were included in the study. There was substantial heterogeneity in both outcomes (resistance proportion, I2=99.59%; prevalence, I2=99.83%), precluding pooled averages, and meta-regression analyses revealed that these variations were explained by country income status and participant characteristics but not by methodological differences in AST. Also, no significant secular changes in MRSA prevalence or resistance proportions in Asia-Pacific were found.

Conclusion: The resistance proportions and prevalence of MRSA infections in Asia-Pacific are comparable with those reported in other regions with no significant secular changes in the past decade. Country income status and characteristics of the sample population explained more variation in the reported resistance proportions and prevalence of MRSA than methodological differences in AST across locations in the region.

Keywords: Antimicrobial resistance; Asia-Pacific; MRSA; Methicillin resistance; Staphylococcus aureus.

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Conflict of interest statement

COMPETING INTERESTS

BJC has received research funding from Sanofi Pasteur for a study of influenza vaccine effectiveness. The authors declare no other potential competing interests.

Figures

Figure 1.
Figure 1.
Flow diagram of study selection.
Figure 2.
Figure 2.
Number of observations reported for MRSA prevalence and resistance proportions in selected locations in the Asia Pacific (2000 – 2016).
Figure 3.
Figure 3.. MRSA prevalence and resistance proportions reported in Asia Pacific by year of publication.
Panel A. MRSA prevalence, defined as the proportion of MRSA among all tested samples, reported in selected countries between year 2000 and 2016. For studies that report prevalence for more than one year, the midpoint of the study is reported as the study year. Bubble sizes reflect the study sample size for each observation. Panel B. MRSA resistance proportion, defined as as the proportion of MRSA among all S. aureus isolates, reported in selected countries between year 2000 and 2016. For studies that report prevalence for more than one year, the midpoint of the study is reported as the study year. Bubble sizes reflect the study sample size for each observation. Panel C. Number of publications that report MRSA prevalence in selected countries in year 2000 – 2017. Panel D. Number of publications that report MRSA prevalence in selected countries in year 2000 – 2017.
Figure 4.
Figure 4.. MRSA prevalence and resistance proportion by source of infection and population segment.
Panel A. MRSA prevalence reported in selected countries by source of patients or persons sampled. Panel B. MRSA prevalence reported in selected countries by source of infection. Panel C. MRSA resistance proportion reported in selected countries by source of patients or persons sampled. Panel D. MRSA resistance proportion reported in selected countries by source of infection. MRSA prevalences and resistance proportions for studies with unknown source of infection or population groups are not included.
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