Determinants of MRSA prevalence in the Asia Pacific Region: a systematic review and meta-analysis.

OBJECTIVE: We aimed to review published literature on methicillin resistant S. aureus (MRSA) in the Asia Pacific Region to document MRSA prevalence in the Region and examine the impact of variability in study design on the reported data of MRSA prevalence.

METHODS: We included studies that reported MRSA prevalence between 2000 and 2016 and excluded studies if they did not contain complete information on antibiotic susceptibility testing (AST) methods Our primary outcomes were the proportion of MRSA isolates among S. aureus isolates (resistance proportion) or among individual samples (prevalence).

FINDINGS: We included 229 studies in 19 countries/territories in this study. There was substantial heterogeneity in both outcomes (resistance proportion: I2 =99·6%, prevalence: I2 =99·8%), precluding pooled averages, and meta-regression analyses revealed that these variations were explained by country income status and participant characteristics but not methodological differences in AST. We also found no significant secular changes in MRSA prevalence or resistance proportions in the Asia Pacific.

CONCLUSION: The resistance proportions and prevalence of MRSA infections in the Asia Pacific is comparable to those reported in other regions with no significant secular changes in the past decade. Country income status and the characteristics of the sample population explained more variations in the reported resistance proportions and prevalence of MRSA than methodological differences in AST across locations in the Region.