Prevalence of methicillin-resistant Staphylococcus aureus in Iran: A systematic review and meta-analysis

Methicillin-resistant Staphylococcus aureus (MRSA) remains a major public health concern, particularly in healthcare settings. This systematic review and meta-analysis aimed to estimate the pooled prevalence of MRSA and characterize SCCmec distribution among clinical isolates in Iran. A comprehensive search of PubMed, Embase, Scopus, and Web of Science identified Iranian studies published up to May 2025. The pooled prevalence of MRSA among human S. aureus isolates was 46.4% (95% CI: 43.6-49.3%, I²= 96.9%, P < 0.001). Publication bias was suggested by Egger's test, and trim-and-fill analysis reduced the pooled estimate from 46.4% to 38.8%. Among 89 studies, type III was the most prevalent (44%), while type IVb was the least common (6%). These findings highlight a substantial MRSA burden and the predominance of hospital-associated clones in Iran. However, the pooled estimates should be interpreted with caution because of the considerable heterogeneity among the included studies. Strengthening infection prevention control and antimicrobial stewardship remains essential.