Methicillin-Resistant Staphylococcus aureus Using Broth Micro Dilution Method in Iran: A Meta-Analysis (2007-2016)

  • Ghobad Moradi Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
  • Seyyede Maryam Bechashk Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
  • Nader Esmailnasab Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
  • Behzad Mohsenpour Department of infectious Disease, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
  • Rashid Ramazanzadeh Cellular and Molecular Research Center and Microbiology Department, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
  • Daem Roshani Department of Epidemiology and Biostatistics, Medical School, Kurdistan University of Sciences, Sanandaj, Iran.
  • Ebrahim Ghaderi Department of Epidemiology and Biostatistics, Medical School, Kurdistan University of Sciences, Sanandaj, Iran.
Keywords: Antimicrobial resistance (AMR), Iran, Methicillin-resistant Staphylococcus aureus, Methicillin, MRSA, Staphylococcus aureus


Background:      Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most signifuicant pathogens in Iran; it is one of the WHO-declared microbial resistance emergencies; and also one of the most important challenges facing the prevalence of resistance. The aim of this study was to detect MRSA using Broth Micro Dilution method and meta-analysis in Iran from 2007 to 2016. Methods:       Persian databases (including Magiran, Irandoc, and SID) and International databases (including pubmed, science direct, and scopus) were searched during this period (2007-2016), such that the high heterogeneity (50% < I2) in this study was analyzed using the DerSimonian Laird method. Data were categorized into subgroups based on year of study and province. Due to the high validity of the diagnosis of organisms and quantitative results, antimicrobial susceptibility test (AST) was used to detect MRSA. Data analysis was performed using statsdirect software. Results:      Based on the available data in medical databases, 678 articles were selected. In total, 29 remaining studies entered the meta-analysis phase. In this study, the overall prevalence of MRSA using MIC is 53% (95% CI: 0.42.31, 63.90); in 2016 it was 77.56% (95% CI: 76.07, 78.99) and in 2007 was 57.49% (95% CI: 53.17, 61.72). The heterogeneity was estimated to be 98.5% (95% CI: 98.4, 98.6). Conclusion:    Based on the results, there is an increasing prevalence of MRSA in Iran. These may be due to the failure or lack of infection control activities and antimicrobial selection pressure.


Ryu S, Head MG, Kim BI, Hwang J, Cho E-H. Are we investing wisely? A systematic analysis of nationally funded antimicrobial resistance projects in Republic of Korea, 2003–2013. Journal of global antimicrobial resistance. 2016;6:90-4.

Jabalameli F, Mirsalehian A, Sotoudeh N, Jabalameli L, Aligholi M, Khoramian B, et al. Multiple-locus variable number of tandem repeats (VNTR) fingerprinting (MLVF) and antibacterial resistance profiles of extended spectrum beta lactamase (ESBL) producing Pseudomonas aeruginosa among burnt patients in Tehran. Burns. 2011;37(7):1202-7.

Planta MB. The role of poverty in antimicrobial resistance. The Journal of the American Board of Family Medicine. 2007;20(6):533-9.

Chambers HF, DeLeo FR. Waves of resistance: Staphylococcus aureus in the antibiotic era. Nature Reviews Microbiology. 2009;7(9):629-41.

Motamedi H, Mirzabeigi H, Shirali T. Determining of antibiotic resistance profile in Staphylococcus aureus isolates. Asian Pacific Journal of Tropical Medicine. 2010;3(9):734-7.

Mahdiyoun SM, Ahanjan M, Goudarzi M, Rezaee R. Prevalence of Antibiotic Resistance in Methicillin-resistant Staphylococcus aureus and Determining Aminoglycoside Resistance Gene by PCR in Sari and Tehran Hospitals. Journal of Mazandaran University of Medical Sciences. 2015;25(128):97-107.

Hassanzadeh S, Pourmand M, Hadadi A, Nourijeylani K, Yousefi M, Mashhadi R, et al. Frequency and Antimicrobial Resistance Patterns of Methicillin-Resistant Staphylococcus aureus in Tehran. Journal of Medical Bacteriology. 2015;2(3-4):41-6.

Wise R. Antimicrobial resistance: priorities for action. Journal of Antimicrobial Chemotherapy. 2002;49(4):585-6.

Ghasemian A, Mirzaee M. Methicillin Resistant Staphylococcus aureus (MRSA) Strains and the Staphylococcal Cassette Chromosome mec Types in Iran. Infection, Epidemiology and Medicine. 2016;2(3):31-4.

Sheikholeslami Z. Prevalence of Staphylococcus aureus nasal carriers and antibiotic resistance among staff of clinical wards in Nikuee Hospital, Qom, Iran, in 2012. communities.4:5.

Asadollahi P, Delpisheh A, Maleki MH, Jalilian FA, Alikhani MY, Asadollahi K, et al. Enterotoxin and Exfoliative Toxin Genes Among Methicillin-Resistant Staphylococcus aureus Isolates Recovered From Ilam, Iran. Avicenna Journal of Clinical Microbiology and Infection. 2014;1(2).

Morgenstern M, Erichsen C, Hackl S, Mily J, Militz M, Friederichs J, et al. Antibiotic resistance of commensal Staphylococcus aureus and coagulase-negative staphylococci in an international cohort of surgeons: a prospective point-prevalence study. PloS one. 2016;11(2):e0148437.

Askarian M, Zeinalzadeh A, Japoni A, Alborzi A, Memish ZA. Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus and its antibiotic susceptibility pattern in healthcare workers at Namazi Hospital, Shiraz, Iran. International Journal of Infectious Diseases. 2009;13(5):e241-e7.

Askari E, Soleymani F, Arianpoor A, Tabatabai SM, Amini A, NaderiNasab M. Epidemiology of mecA-methicillin resistant Staphylococcus aureus (MRSA) in Iran: a systematic review and meta-analysis. Iranian journal of basic medical sciences. 2012;15(5):1010.

Klevens RM, Morrison MA, Nadle J, Petit S, Gershman K, Ray S, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. Jama. 2007;298(15):1763-71.

Ekrami A, Kayedani A, Jahangir M, Kalantar E. Isolation of common aerobic bacterial pathogens from the environment of seven hospitals, Ahvaz, Iran. Jundishapur Journal of Microbiology. 2011;4(2):75-82.

Morens DM, Fauci AS. Emerging infectious diseases: threats to human health and global stability. PLoS pathogens. 2013;9(7):e1003467.

Spellberg B, Powers JH, Brass EP, Miller LG, Edwards Jr JE. Trends in antimicrobial drug development: implications for the future. Clinical Infectious Diseases. 2004;38(9):1279-86.

Boucher HW, Corey GR. Epidemiology of methicillin-resistant Staphylococcus aureus. Clinical infectious diseases. 2008;46(Supplement_5):S344-S9.

Lenton S, Single E. The definition of harm reduction. Drug and Alcohol Review. 1998;17(2):213-20.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. International Journal of Surgery. 2014;12(12):1495-9.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine. 2009;6(7):e1000097.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ: British Medical Journal. 2003;327(7414):557.

Lin J, Peng Y, Xu P, Zhang T, Bai C, Lin D, et al. Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Chinese Children: A Prevalence Meta-Analysis and Review of Influencing Factors. PloS one. 2016;11(7):e0159728.

Deng J, Wan C, Mu D, Zhou W, Xu A, Fan J, et al. Nasal carriage of community-acquired staphylococcus aureus and drug sensitivity tests in healthy children in Chengdu. Sichuan da xue xue bao Yi xue ban= Journal of Sichuan University Medical science edition. 2012;43(3):391-4.

Sterne JA, Egger M. Regression methods to detect publication and other bias in meta-analysis. Publication bias in meta-analysis: Prevention, assessment and adjustments. 2005:99-110.

Higgins J, Thompson S, Deeks J, Altman D. Statistical heterogeneity in systematic reviews of clinical trials: a critical appraisal of guidelines and practice. Journal of health services research & policy. 2002;7(1):51-61.

Carlet J, Jarlier V, Harbarth S, Voss A, Goossens H, Pittet D. Ready for a world without antibiotics? The pensières antibiotic resistance call to action. Antimicrobial resistance and infection control. 2012;1(1):11.

Rahimi-Alang S, Asmar M, Cheraghali F, Yazarlou S, Amini A, Shakeri F, et al. Frequency of methicillin resistant Staphylococcus aureus in health care. Zahedan Journal of Research in Medical Sciences. 2011;13(1):17-22.

Mahmoodzadeh Hosseini H, Kiyani N, Amin M, Hedayati Ch M, Imani Fooladi AA. Distribution of high-level mupirocin resistance among clinical MRSA. Journal of Chemotherapy. 2017;29(4):215-9.

Mohammadi S, Sekawi Z, Monjezi A, Maleki M-H, Soroush S, Sadeghifard N, et al. Emergence of SCCmec type III with variable antimicrobial resistance profiles and spa types among methicillin-resistant Staphylococcus aureus isolated from healthcare-and community-acquired infections in the west of Iran. International Journal of Infectious Diseases. 2014;25:152-8.

Mohajeri P, Farahani A, Davoodab A. Prevalence of vancomycin resistance in methicillin-resistant Staphylococcus aureus. Journal of Kerman University of Medical Sciences. 2014;21(5).

Stefani S, Varaldo P. Epidemiology of methicillin‐resistant staphylococci in Europe. Clinical Microbiology and Infection. 2003;9(12):1179-86.

Kali A, Stephen S, Sivaraman Umadevi SK, Joseph NM, Srirangaraj S. Changing trends in resistance pattern of methicillin resistant Staphylococcus aureus. Journal of clinical and diagnostic research: JCDR. 2013;7(9):1979.

Stefani S, Chung DR, Lindsay JA, Friedrich AW, Kearns AM, Westh H, et al. Meticillin-resistant Staphylococcus aureus (MRSA): global epidemiology and harmonisation of typing methods. International journal of antimicrobial agents. 2012;39(4):273-82.

Perovic O, Iyaloo S, Kularatne R, Lowman W, Bosman N, Wadula J, et al. Prevalence and trends of Staphylococcus aureus bacteraemia in hospitalized patients in South Africa, 2010 to 2012: laboratory-based surveillance mapping of antimicrobial resistance and molecular epidemiology. PloS one. 2015;10(12):e0145429.

Hasibi M, Iravani B. Prevalence of Methicillin and Vancomycin resistant Staphylococcus aureus colonization in nasopharynx Amir-Alam hospital, 2005. Tehran University Medical Journal TUMS Publications. 2007;65(3):78-81.

How to Cite
Moradi G, Bechashk SM, Esmailnasab N, Mohsenpour B, Ramazanzadeh R, Roshani D, Ghaderi E. Methicillin-Resistant Staphylococcus aureus Using Broth Micro Dilution Method in Iran: A Meta-Analysis (2007-2016). J Med Bacteriol. 7(3-4):17-29.
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