Research report: Methicillin-resistant Staphylococcus aureus (MRSA): a systematic review and meta-analysis of prevalence and antibiotic resistance patterns in clinical isolates at health-care settings of South Asia

A systematic review and meta-analysis of clinical isolates from South Asian health-care settings found that methicillin-resistant Staphylococcus aureus represented a pooled 44.3% of the S. aureus isolates examined. The estimate had a 95% confidence interval of 40.2% to 48.4% and was based on 31,029 S. aureus isolates identified in 75 clinical studies, including 12,160 MRSA isolates. The research combined published reports from 2001 through 2025 concerning clinical samples collected from South Asian patients.

Although the result indicates a high pooled prevalence of MRSA among the studied S. aureus isolates, the authors emphasized extensive variation among the underlying reports and said the estimate should not be interpreted as a uniform rate for every country, hospital or patient group. The investigators followed a PRISMA-based procedure for selecting studies and extracted data on MRSA prevalence and antibiotic resistance patterns. They pooled prevalence estimates with a DerSimonian–Laird random-effects model and assessed variation through forest plots, subgroup analyses, funnel plots, Egger’s regression and the I² statistic.

The meta-analysis found very high heterogeneity across the included reports, with I² = 96.7% and p < 0.001. Funnel-plot analysis suggested minor publication bias, while Egger’s test did not detect a statistically significant publication-bias effect ( p = 0.106). The review also used Pearson correlation analysis, hierarchical clustering and heat-map visualization to examine patterns in the collected data.

These methods characterize differences among reports, but they do not establish why those differences occurred. Country-level subgroup results showed marked variation in the pooled estimates. Bangladesh had the highest reported pooled MRSA prevalence at 52.9%, while Pakistan had the lowest at 37.8%.

These country estimates are summaries of the available clinical studies rather than direct measurements of every South Asian health-care setting. The review noted that regional variation may be related to differences in diagnosis, treatment regimens and management, but the observational evidence did not establish which factors produced the differences. The authors also noted that a temporal rise in the MRSA burden has been reported over the preceding decade.

The review also assembled antibiotic susceptibility results for the MRSA isolates. Penicillin and ampicillin each had susceptibility below 10% against MRSA, while vancomycin had the highest pooled susceptibility among the assessed antibiotics, at 98.0%. The analysis nevertheless included reports of mitigated vancomycin susceptibility and vancomycin-resistant Staphylococcus aureus .

Those reports were heterogeneous observations from individual studies and do not alter the meaning of the pooled estimate: 98.0% represented the combined result across the available data rather than a guarantee for every institution or isolate. The authors said the reports of diminished susceptibility and vancomycin resistance underscore the need for judicious antimicrobial use and continued antimicrobial surveillance. The findings do not, by themselves, quantify the number of resistant isolates across the region, compare treatment outcomes or demonstrate that a particular prescribing policy would reduce MRSA prevalence.

Overall, the synthesis identifies a high pooled prevalence of MRSA among clinical S. aureus isolates in South Asian health-care settings, alongside substantial differences between countries and exceptionally high heterogeneity among studies. The 44.3% estimate is best understood as a statistical summary of 75 reports rather than a precise rate for an individual hospital or patient population. Despite those limitations, the analysis shows that MRSA constituted a substantial share of the S. aureus isolates represented in the included data.

The authors concluded that continued antimicrobial surveillance is warranted, particularly as some reports described diminished vancomycin susceptibility or vancomycin-resistant S. aureus , while the regional prevalence estimates require careful interpretation because of their extensive heterogeneity.

Subject of Research: Meta-analysis of MRSA prevalence and antibiotic resistance patterns in clinical Staphylococcus aureus isolates from South Asian health-care settings

Article Title: Methicillin-resistant Staphylococcus aureus (MRSA): a systematic review and meta-analysis of prevalence and antibiotic resistance patterns in clinical isolates at health-care settings of South Asia

Article References: Singh, I., Singh, H., Keshri, A., Sharma, D., Maurya, A. K., Kumar, A., Dhakad, M. S., & Beg, M. M. A. (2026). Methicillin-resistant Staphylococcus aureus (MRSA): a systematic review and meta-analysis of prevalence and antibiotic resistance patterns in clinical isolates at health-care settings of South Asia. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14368-2

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14368-2

Keywords: MRSA, Staphylococcus aureus, South Asia, antimicrobial resistance, systematic review, meta-analysis, clinical isolates, vancomycin, antibiotic susceptibility, health-care surveillance, Methicillin-resistant, Staphylococcus