PREVALENCE OF MACROLIDE RESISTANCE AMONG METHICILLIN-RESISTANT Staphylococcus aureus (MRSA): A META ANALYTIC ASSESSMENT

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.