LAUSR

BACKGROUND AND AIM Staphylococcus aureus (S. aureus) is one of the most common pathogens causing nosocomial and community-acquired infections which associate with high morbidity and mortality rates. Mupirocin has been increasingly used for treatment of S. aureus (MSSA) and methicillin resistant S. aureus (MRSA) infections. The aim of the present study, was to determine the precise prevalence of Mupirocin Resistant S. aureus (MuRSA), Mupirocin Resistant MRSA (MuRMRSA), High Level MuRSA (HLMuRSA) and High Level MuRMRSA (HLMuRMRSA) on a global scale. METHODS Several international databases including Medline, Embase, and the Web of Sciences were searched (2000-2018) to discern studies addressing the prevalence of MuRSA, MuRMRSA, HLMuRSA, and HLMuRMRSA. STATA (version14) software was used to interpret the data. RESULTS Of the 2243 records identified from the databases, 30 and 63 studies fulfilled the eligibility criteria for MuRSA and MuRMRSA, respectively. Finally, 27 and 60 studies were included separately for HLMuRSA and HLMuRMRSA, respectively. The analyses manifested that the prevalence of MuRSA, MuRMRSA, HLMuRSA and HLMuRMRSA was 7.6% [95% confidence interval (95% CI) 6.2-9.0], 13.8% [(95% CI) 12.0-15.6], 8.5% [(95% CI) 6.3-10.7] and 8.1% [(95% CI) 6.8-9.4], respectively. CONCLUSION Overall our results show a global increase in the prevalence of HLMuRSA and HLMuRMRSA among clinical S. aureus isolates over time. However, there was only a significant increase in the prevalence of MuRMRSA compared to the other categories of strains especially MuRSA. Since for decolonization of MSSA and MRSA in both patients and healthcare personnel, mupirocin is currently still the most effective antibiotic, a reduction of its effectiveness can provide a risk for invasive infection. Monitoring of mupirocin resistance development remains critical.