Trends of methicillin-resistant S. aureus (MRSA) in Iran (۲۰۱۳-۲۰۲۳): A SystematicReview and Meta-Analysis

Introduction:Staphylococcus aureus is a major pathogen responsible for hospital- and community-acquired infections,contributing to significant morbidity and mortality globally. The emergence and spread of methicillin-resistantStaphylococcus aureus (MRSA) have posed substantial public health challenges in recent decades. This studyaimed to evaluate the dynamic patterns of MRSA prevalence in Iran, focusing on geographic distribution andtemporal trends in antibiotic resistance.Methods:A systematic review was conducted from ۲۰۱۳ to ۲۰۲۳ using PubMed, Scopus, Embase, SID, and Web of Scienceto identify studies addressing MRSA prevalence in Iran. A comprehensive meta-analysis (RStudio version ۴.۳.۳)was performed. Out of ۱۰,۱۲۹ identified cases, ۸۴% were linked to inpatients and ۱۶% to outpatients, with ۶۶studies meeting the eligibility criteria.Results:The analysis revealed considerable geographic variation in MRSA prevalence. The prevalence was highest in thenorthern region (۵۶% [۹۵% CI: ۰.۴۸–۰.۶۵]) and lowest in the western region (۳۶% [۹۵% CI: ۰.۱۰–۰.۶۷]). Theprevalence in the southern (۴۶% [۹۵% CI: ۰.۲۰–۰.۷۴]), eastern (۴۷% [۹۵% CI: ۰.۳۸–۰.۵۵]), and central regions(۴۹% [۹۵% CI: ۰.۴۰–۰.۵۷]) highlighted its nationwide burden. Temporal analysis showed an increase in MRSAprevalence from ۴۶% [۹۵% CI: ۰.۳۸–۰.۵۴] in ۲۰۱۳–۲۰۱۸ to ۵۰% [۹۵% CI: ۰.۴۰–۰.۶۰] in ۲۰۱۹–۲۰۲۴, indicating agrowing trend.Conclusion:This study underscores the significant and rising burden of MRSA in Iran, particularly in hospital settings. Theobserved geographic and temporal patterns call for urgent implementation of targeted infection control strategies,robust antibiotic stewardship programs, and continued surveillance to mitigate the public health impact of MRSA.