The Prevalence of Methicillin-resistant Staphylococcus aureus in Clinical Settings of Pakistan: A Systematic Review...

Methicillin-resistant Staphylococcus aureus (MRSA) represents a significant and growing public health challenge in Pakistan, due to antibiotic misuse, weak infection control measures and rapid bacterial evolution. Determining the overall prevalence of MRSA in the country is crucial for informing targeted treatment protocols and effective management strategies. This study conducted a systematic review and meta-analysis to establish the pooled prevalence of MRSA in Pakistan.

We searched electronic databases (Google Scholar, PubMed, Embase) for studies published between 2015 and 2025. The PRISMA guidelines were followed to conduct this systematic review. Meta-analyses were performed using R Studio software, applying both fixed- and random-effects models to calculate pooled prevalence. The heterogeneity was assessed using the I² statistics. Publication bias was assessed using Begg's and Egger's tests. Most studies used cefoxitin disk diffusion to characterize MRSA, while some studies used PCR to detect the mecA gene.

Sixty-eight studies meeting the inclusion criteria were analyzed. The overall pooled MRSA prevalence was estimated at 50% (95% CI: 45-54%), with I² = 98.9). Year-wise subgroup analysis revealed significant variation from 2015 to 2025, with estimates ranging from 64% (95% CI: 26-90%), with I² = 96.68 in 2022 to a low of 34% (95% CI: 17-56%), with I² = 99.16 in 2020, which may be due to reduced healthcare access and infection control measures implemented during the COVID-19 lockdowns. The pooled estimate among general patients and healthcare personnel was 50% (95% CI: 44-57%), with I² = 98.5 and 44% (95% CI: 30-60%), with I² = 95.4, respectively. The subgroup differences test (p = 0.54) for population type revealed no statistically significant difference. The Begg's test (p = 0.2378) and Egger's test (p = 0.8893) showed no significant evidence of bias. The significant variation between the two diagnostic methods (p = 0.03) showed that the observed heterogeneity may be due to diagnostic methods used across the studies.

The high pooled prevalence of MRSA in Pakistan highlights an urgent need for strengthened antimicrobial stewardship, standardized surveillance systems, and integrated infection prevention strategies.