Epidemiology of toxic shock syndrome toxin-1 harboring Staphylococcus aureus obtained from clinical samples in Iran: A Systematic Review and Meta-analysis.

BACKGROUND: S. aureus strains, with the capability of producing toxic shock syndrome toxin-1 (TSST-1), are more likely to cause complicated infections. However, due to lack of comprehensive local data on the prevalence of TSST-1, we aimed to determine the prevalence of TSST-1 harboring S. aureus isolates in Iran.

METHODS: A systematic search was performed by using PubMed and Scopus databases from papers published by Iranian authors from January 2000 to the end of March 2017. Then, 10 publications which were matched with inclusion criteria were selected for data extraction and analysis by Comprehensive Meta-Analysis Software.

RESULTS: The overall prevalence of TSST-1 carrying S. aureus in Iran was 21.3% (95% CI: 7.9%-46.1%), ranging from 0% to 68%. Moreover, from the included studies, the pooled prevalence of TSST-1 producing MRSA isolates was estimated to be 25.2% (95% CI: 13.3%-42.5%), ranging from 0% to 69.8%. From those studies which showed the distribution of toxin-harboring S. aureus it was found that the skin and soft tissue, respiratory and bloodstream infections were the common sites of TSST-1 harboring S. aureus.

CONCLUSIONS: In summary, it seems that emergence of MRSA strains leads to higher prevalence of TSST-1 carrying strains in the north of Iran. However, further research is required to elucidate the interplay between the outcome of diseases and TSST-1 producing strains, especially in our country.