Azzam Ahmed, Khaled Heba, Fayed Heba Mohamed, Mansour Youssef, Eldalil Mariam, Elshennawy Eslam, Salem Haitham, Elkatan Hoda A
Department of Microbiology and Immunology, Faculty of Pharmacy, Helwan University, Cairo, Egypt.
Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
BMC Infect Dis. 2025 Apr 11;25(1):505. doi: 10.1186/s12879-025-10819-4.
MRSA represents a significant public health challenge, particularly in resource-constrained regions like Africa. A critical factor in its spread is the role of asymptomatic carriers, who not only facilitate transmission but also face a markedly higher risk of developing MRSA-related infections. Against this backdrop, the current meta-analysis provides a comprehensive evaluation of MRSA colonization rates, associated risk factors, and antibiotic resistance profiles across African populations.
A comprehensive literature search was conducted across African Journals Online, African Index Medicus, PubMed, Scopus, Google Scholar, and Web of Science from January 1, 2014, to January 1, 2025. Eligible studies reported on MRSA colonization rates, associated risk factors, or antibiotic resistance patterns within African populations. Results were presented as pooled prevalence or risk ratios (RR) with 95% confidence intervals, employing a random-effects model in R software (meta package). A p-value of < 0.05 was considered statistically significant. The study followed the PRISMA guidelines throughout.
Sixty-nine studies with 23,484 participants from 16 African countries were included. Subgroup analyses identified Healthcare Workers and hospitalized patients as having the highest pooled prevalence at 13.6% and 12.9%, respectively. Conversely, lower prevalence rates were observed among healthy community residents and children, at 4.1% and 4.7%, respectively. Among HCWs, Egypt reported the highest MRSA colonization rate at 18.1%. Key risk factors for MRSA colonization include a history of hospitalization (RR: 2.2), prior antibiotic use (RR: 1.4), diabetes mellitus (RR: 4.4), HIV with CD4 < 200 cells/µL (RR: 2.8), invasive procedures (RR: 4.8), and being a nurse compared to a physician (RR: 1.8), all with p < 0.05. Antibiotic resistance of MRSA was low for linezolid (2.7%) and vancomycin (5.9%), but higher for mupirocin (10.7%), clindamycin (23.6%), and Trimethoprim/sulfamethoxazole (38.9%).
MRSA colonization is a significant public health challenge in Africa, particularly among healthcare workers and hospitalized patients. Implementing targeted interventions for these high-risk groups can effectively reduce MRSA transmission and overall infection burden. Continuous monitoring is essential, especially given the resistance to mupirocin, a key antibiotic used for MRSA decolonization.
耐甲氧西林金黄色葡萄球菌（MRSA）是一项重大的公共卫生挑战，在非洲等资源有限的地区尤为如此。其传播的一个关键因素是无症状携带者的作用，他们不仅促进传播，而且发生与MRSA相关感染的风险明显更高。在此背景下，当前的荟萃分析全面评估了非洲人群中的MRSA定植率、相关危险因素和抗生素耐药谱。
于2014年1月1日至2025年1月1日在《非洲在线期刊》《非洲医学索引》、PubMed、Scopus、谷歌学术和科学网进行了全面的文献检索。符合条件的研究报告了非洲人群中的MRSA定植率、相关危险因素或抗生素耐药模式。结果以合并患病率或风险比（RR）及95%置信区间呈现，在R软件（meta包）中采用随机效应模型。p值<0.05被认为具有统计学意义。该研究全程遵循PRISMA指南。
纳入了来自16个非洲国家的69项研究，共23484名参与者。亚组分析确定医护人员和住院患者的合并患病率最高，分别为13.6%和12.9%。相反，健康社区居民和儿童的患病率较低，分别为4.1%和4.7%。在医护人员中，埃及报告的MRSA定植率最高，为18.1%。MRSA定植的关键危险因素包括住院史（RR：2.2）、既往使用抗生素（RR：1.4）、糖尿病（RR：4.4）、CD4<200细胞/μL的HIV感染（RR：2.8）、侵入性操作（RR：4.8）以及与医生相比为护士（RR：1.8），所有p值均<0.05。MRSA对利奈唑胺（2.7%）和万古霉素（5.9%）的耐药性较低，但对莫匹罗星（10.7%）、克林霉素（23.6%）和甲氧苄啶/磺胺甲恶唑（38.9%）的耐药性较高。
MRSA定植是非洲的一项重大公共卫生挑战，尤其是在医护人员和住院患者中。对这些高危人群实施有针对性的干预措施可有效减少MRSA传播和总体感染负担。持续监测至关重要，特别是考虑到对莫匹罗星（一种用于MRSA去定植的关键抗生素）的耐药情况。
