Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal; Active Pharmacy Pvt. Ltd., Kathmandu, Nepal.
Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.
Int J Infect Dis. 2021 Feb;103:48-55. doi: 10.1016/j.ijid.2020.11.152. Epub 2020 Nov 18.
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.
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.
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 = 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%.
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.
耐甲氧西林金黄色葡萄球菌（MRSA）是全球范围内一个重大的健康威胁和公共负担，尤其是在包括尼泊尔在内的发展中国家，因为这些国家医疗保健水平低且对抗生素的不合理使用。MRSA 菌株在尼泊尔的医院中经常被检测到，但报告率却很低。因此，为了在国家层面全面、清晰地了解 MRSA 感染情况，本系统评价和荟萃分析评估了尼泊尔 MRSA 的流行率和抗菌药物敏感性模式。
检索了 2008 年 1 月 1 日至 2020 年 8 月 31 日期间发表的研究，包括 PubMed、EMBASE、Cochrane 中心、Google Scholar 和尼泊尔数据库。共选择了 26 篇原始文章进行定量分析。由三位作者独立进行数据提取，并使用 MedCalc 版本 19.5.1 和 Comprehensive Meta-Analysis（CMA）软件 v.3.0 进行荟萃分析。
在 5951 例确诊的金黄色葡萄球菌分离株中，MRSA 感染的总流行率为 38.2%（95%CI，31.4%-45.2%）。我们发现研究之间存在显著的异质性（I = 96.7%，耐药比例），且无发表偏倚的证据（p = 0.256）。MRSA 菌株对β-内酰胺类抗生素表现出高度耐药性，而对万古霉素的敏感性最高，为 98.0%，其次是氯霉素，为 91.0%。
分析表明，尼泊尔的整体 MRSA 负担相当高，MRSA 感染的流行率呈上升趋势。健全的立法、明确的抗生素政策和实施控制干预措施对于解决 MRSA 感染和整体抗菌药物耐药性至关重要。
