Abstract:
Methicillin-resistant Staphylococcus aureus (MRSA) is a globally significant
pathogen characterized by high virulence and exceptional adaptability. It shows
resistance to multiple antibiotics, particularly β-lactams due to the mecA gene. This
meta-analysis examined the widespread transmission of MRSA, which evades host
defenses and thrives in various environments, focusing on the prevalence of
macrolide resistance. Macrolides, such as azithromycin, clarithromycin, and
erythromycin, are antibiotics that inhibit bacterial growth by disrupting protein
synthesis. Drawing from 101 studies identified through a comprehensive search
including PubMed, the analysis adhered to PRISMA guidelines and included only
cross-sectional studies reporting baseline resistance data in MRSA strains. Using
a random-effects model, the pooled prevalence of macrolide resistance was
calculated at 88.51% (95% CI: 84.76–91.43), revealing a high burden of resistance
with significant heterogeneity (I² = 98.23%, τ² = 2.9087, Q = 6483.68, p< 0.0001).
Subgroup analyses showed 90.22% resistance for erythromycin, 79.96% for
azithromycin, and 61.47% for clarithromycin. Each showed varying heterogeneity,
reflecting study variability from geographic, methodological, and temporal
differences. Evidence of publication bias was detected through Begg’s rank
correlation and Egger’s regression tests, with statistically significant results
(p=0.0000), suggesting potential overrepresentation of studies with positive
findings. These findings underscore the clinical challenge posed by macrolide
resistant MRSA, limiting the efficacy of a widely used class of antibiotics. This
emphasises the need for regional surveillance, antimicrobial stewardship, and
tailored therapeutic strategies guided by local susceptibility profiles. The extreme
heterogeneity underscores the need for customized interventions and ongoing
research into resistance mechanisms and epidemiology. This study offers vital
insights into the extent and diversity of macrolide resistance in MRSA, supporting
public health efforts to combat antibiotic resistance in community and healthcare
settings.
