Prevalence of Methicillin-Resistant Staphylococcus aureus in Livestock in Japan: A Systematic Review and Meta-Analysis

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an important health issue that is estimated to have caused 130,000 deaths worldwide in 2021. As more instances of cross-species transmission of MRSA have been reported, concerns have been raised regarding the spread of livestock-associated MRSA to humans. The prevalence of MRSA in livestock varies globally. This study systematically reviews the prevalence of MRSA at the farm and animal levels in Japan. Methods: Relevant studies published in English or Japanese between 2000 and 2023 were retrieved from four databases. Pooled prevalences at the farm and animal levels in Japanese farms were calculated using a random-effects model. Subgroup and meta-regression analyses were also performed to explore sources of heterogeneity. Results: The 13 studies included in this meta-analysis yielded an MRSA prevalence of 3.54% (95% confidence interval [CI] 0.65-8.30%) at the individual pig level, 13.07% (95% CI 5.42-23.04%) at the pig farm level, 0.0% (95% CI 0.00-0.04%) at the individual cattle level, and 0% (95% CI 0.00-0.44%) at the individual chicken level. A significant increase in MRSA prevalence over time was evident at the individual pig level by both subgroup analysis (p = 0.020) and meta-regression (p = 0.019). Conclusions: Our results indicated that the proportion of pigs that can be a source of MRSA infection in humans has been steadily increasing in Japan. Despite some limitations, our findings strongly imply a need for more attention to pig-to-human MRSA transmission in Japan.