Proportion and antibiogram of methicillin-resistant Staphylococcus aureus (MRSA) in Africa: a systematic review and meta-analysis

Abstract

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a major public health concern, particularly in resource-limited settings such as Africa. This meta-analysis aimed to determine the proportion of MRSA among S. aureus isolates from patients with confirmed infections and to assess associated antibiotic resistance profiles across the continent. METHODS: A comprehensive literature search was conducted in African Journals Online, African Index Medicus, PubMed, Scopus, Google Scholar, and Web of Science for studies published between January 1, 2013, and June 5, 2024. Primary studies were included if they reported MRSA proportion or resistance profiles in Africa, employed reliable detection techniques, and analyzed clinical specimens from infected patients. Statistical analyses were performed using the meta package in R software, applying a random-effects model. A p-value of < 0.05 was considered statistically significant. RESULTS: This meta-analysis included 191 studies, encompassing 40,979 S. aureus isolates. Nigeria contributed the highest number of studies (n = 29), followed by Egypt (n = 26). The vast majority of studies (n = 186) were based on hospital settings. The pooled proportion of MRSA in Africa was 42.2% (95% CI 38.7-45.6). By detection method, proportion was 41.4% for mecA, 42.8% for the cefoxitin disc method, and 39.1% for the oxacillin disc method, with no significant differences observed (p = 0.8). Regionally, Northern Africa had a significantly higher proportion of 56.2% (95% CI 49.3-62.9) compared with 36.7% (95% CI 33.2-40.4) in Sub-Saharan Africa (p < 0.001). At the country level, Eritrea reported the highest proportion (71.8%), followed by Egypt (61.8%), while the lowest rates were observed in Malawi (7.0%) and Gabon (8.2%). Regarding MRSA resistance profiles, linezolid (3.4%) and vancomycin (4.7%) showed the lowest resistance rates, whereas higher rates were noted for fusidic acid (11.6%), rifampin (28.4%), clindamycin (40.4%), trimethoprim-sulfamethoxazole (54.5%), and tetracycline (60.2%). Limited data were available for telavancin, dalbavancin, oritavancin, tedizolid, ceftaroline, mupirocin, and daptomycin. CONCLUSION: The proportion of MRSA in Africa remains high at 42.2%, with marked regional disparities. Although resistance rates for linezolid and vancomycin are relatively low, they surpass global averages, raising concerns about emerging resistance. Alarmingly high resistance rates to several other antibiotics further underscore the urgent need for targeted interventions and continuous surveillance.