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Global prevalence of macrolide-resistant Staphylococcus spp.: a comprehensive systematic review and meta-analysis
Tahereh Navidifar1, Abbas Zare Banadkouki2,3, Elnaz Parvizi4
1Department of Basic Sciences, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran.
Background:
Staphylococcus is a genus of bacteria responsible for various infections ranging from mild skin to severe systemic diseases. Methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci (CoNS) are significant challenges owing to their resistance to multiple antibiotics, including macrolides, such as erythromycin, clarithromycin, and azithromycin.
Objective:
This study aimed to systematically review and synthesize data on the prevalence of macrolide resistance in Staphylococcus spp., identify trends and changes in resistance patterns over time, and assess how testing methods and guidelines affect reported resistance rates.
Methods:
The study conducted a systematic search of the Scopus, PubMed, Web of Science, and EMBASE databases. Studies have reported the proportion of macrolide-resistant Staphylococcus spp. Two authors independently extracted and analyzed the data using a random-effects model. Heterogeneity was assessed, and subgroup analyses were performed based on country, continent, species, AST guidelines, methods, and period.
Results:
In total, 223 studies from 76 countries were included. The pooled prevalence of resistance to erythromycin, clarithromycin, and azithromycin were 57.3, 52.6, and 57.9%, respectively. Significant heterogeneity was observed across studies (I2 > 95%, p < 0.001). Oceania (72%) had the highest erythromycin resistance, whereas Europe had the lowest (40.7%). Subgroup analyses revealed variations in resistance based on the species, with higher resistance in MRSA than in MSSA and CoNS than in other species. Over time, a slight decrease in erythromycin resistance has been observed (59.6% from 2015-2019 to 55% from 2020-2023).
Conclusion:
This study emphasizes the high prevalence of macrolide resistance in Staphylococcus spp. and its notable regional variation. These findings highlight the necessity for standardized methodologies and global surveillance to manage macrolide resistance effectively. Controlling antibiotic resistance should prioritize enhancing public health measures and updating treatment guidelines.
Systematic Review Registration:
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=557756, CRD42024557756.
Insights
Macrolide resistance in Staphylococcus bacteria, including MRSA, remains high globally, with significant regional variations. Findings underscore the need for standardized methods and updated guidelines to combat antibiotic resistance effectively.
Area of Science:
- Microbiology
- Infectious Diseases
- Public Health
Background:
- Staphylococcus species cause diverse infections, with MRSA and CoNS posing significant challenges due to multidrug resistance.
- Macrolide antibiotics like erythromycin, clarithromycin, and azithromycin are frequently ineffective against resistant Staphylococcus strains.
Purpose of the Study:
- To systematically review and synthesize data on macrolide resistance prevalence in Staphylococcus spp.
- To identify temporal trends and geographical variations in macrolide resistance patterns.
- To assess the impact of testing methodologies and guidelines on reported resistance rates.
Main Methods:
- A systematic literature search was conducted across Scopus, PubMed, Web of Science, and EMBASE databases.
- Data from 223 studies across 76 countries were extracted and analyzed using a random-effects model.
- Subgroup analyses explored variations by country, continent, species, and testing guidelines.
Main Results:
- Pooled prevalence of resistance was 57.3% for erythromycin, 52.6% for clarithromycin, and 57.9% for azithromycin.
- Significant heterogeneity was observed; Oceania reported the highest erythromycin resistance (72%), while Europe had the lowest (40.7%).
- Resistance varied by species (higher in MRSA and CoNS) and showed a slight decrease in erythromycin resistance from 2015-2019 to 2020-2023.
Conclusions:
- High and regionally varied macrolide resistance in Staphylococcus spp. necessitates global surveillance and standardized methodologies.
- Effective management requires enhanced public health measures and updated antibiotic treatment guidelines.
- Addressing antibiotic resistance is crucial for public health and patient outcomes.
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