Methicillin-resistant Staphylococcus aureus in Nepal: A systematic review and meta-analysis

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant health threat and public burden worldwide, particularly in developing countries, including Nepal, due to its low healthcare standards and irrational use of antibiotics. It is evident that MRSA strains are frequently detected in Nepalese hospitals; however, they remain underreported. Therefore, to provide a comprehensive and clear understanding of MRSA infection at the national level, this systematic review and meta-analysis evaluated the prevalence and antimicrobial susceptibility patterns of MRSA in Nepal. Methods: PubMed, EMBASE, Cochrane CENTRAL, Google scholar, and Nepalese databases were searched for studies published between 1st January 2008 and 31st August 2020. A total of 26 original articles were selected for quantitative analysis. Data extraction was accomplished by three authors independently and meta-analysis was performed using MedCalc Version 19.5.1 and Comprehensive Meta-Analysis (CMA) software v.3.0. Result: The pooled prevalence of MRSA infections among 5951 confirmed S. aureus isolates was 38.2% (95% CI, 31.4%-45.2%). We found a significant heterogeneity (I-2 = 96.7% for resistance proportion), and no evidence of publication bias (p = 0.256) among studies. MRSA strains showed a high level of resistance to beta-lactam antibiotics and the highest susceptibility profile was noted in vancomycin 98.0% followed by chloramphenicol 91.0%. Conclusion: The analysis revealed that the overall MRSA burden in Nepal is considerably high and the prevalence of MRSA infections is in the increasing trend. Sound legislation, definite antibiotic policy, and implementations of control interventions are indispensable for tackling MRSA infection and antimicrobial resistance as a whole. (c) 2020 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/).