Antibiotic Resistance Patterns of Staphylococcus aureus Isolates from Retail Foods in Mainland China: A Meta-Analysis

Foodborne Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), is increasingly threatening human health. Pooled prevalence rates of S. aureus contamination have been extensively studied in retail food products in mainland China, but data regarding antibiotic resistance rates of S. aureus remain scattered. This study was designed to collect researches published between 2007 and 2017 in mainland China and to evaluate the antibiotic resistance of S. aureus from retail foods using a meta-analytic approach. We systematically searched the China National Knowledge Infrastructure (CNKI) and Web of Science databases to identify peer-reviewed literature. A number of multilevel random-effects models were fitted to estimate mean occurrence rates of antibiotic-resistant S. aureus, and subgroup analyses were performed to compare antibiotic resistance rates of S. aureus throughout the years and among the methods to determine the antimicrobial susceptibility. Among the considered antibiotics, S. aureus showed the highest resistance rate to penicillin G (87%, 95% confidence interval [CI] 83-90%), followed by ampicillin (72%, 95% CI 62-81%) and erythromycin (41%, 95% CI 36-46%). MRSA showed the highest resistance rate to ampicillin (98%, 95% CI 89-100%), followed by oxacillin (97%, 95% CI 80-100%) and penicillin G (96%, 95% CI 89-99%). Multidrug resistance (MDR) of S. aureus was most frequently observed to three antibiotics (17%, 95% CI 12-22%), and MRSA showed the highest resistance rate to four antibiotics (24%, 95% CI 5-67%). Subgroup analyses results proved that sources of heterogeneity among studies were neither publication year nor detection method. In conclusion, the meta-analysis showed that β-lactam antibiotics resistance of S. aureus and MRSA strains isolated from retail foods remained the most serious, and MDR of S. aureus and MRSA were also observed. Therefore, it is important to monitor the antibiotic resistance of S. aureus and MRSA in food chain, and food safety measures should be taken to reduce the transmission of this bacterium from foods to human beings.