Antibiotic resistance and sequence type diversity of methicillin resistance Staphylococcus aureus in human and wastewater of southeast Asian countries: A systematic review and meta analysis | ||||
| Microbes and Infectious Diseases | ||||
| Articles in Press, Accepted Manuscript, Available Online from 27 May 2025 | ||||
| Document Type: Systematic review or meta-analysis | ||||
| DOI: 10.21608/mid.2025.372616.2666 | ||||
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| Authors | ||||
Hafiz Shaheer Ahmad  1; Yulia Rosa Saharman 2; Dodi Safari 3
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| 1Department of Microbiology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia | ||||
| 2Department of Microbiology, Faculty of Medicine, University of Indonesia – Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia | ||||
| 3Eijkman Research Center for Molecular Biology, National Research and Innovation Agency, Cibinong, West Java, Indonesia | ||||
| Abstract | ||||
| Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant worldwide health threat, responsible for a high burden of hospital and community-acquired infections. Aim: This review aims to elucidate the diversity and prevalence of MRSA sequence types (STs), SCCmec types and antibiotic resistance genes (ARGs) in Southeast Asia. Method: Following the PRISMA guideline, we analyzed peer-reviewed studies from 2013 to 2024 using Scopus, PubMed, and Google Scholar. We included 33 studies reporting on MRSA STs (n = 23), SCCmec types (n = 24), and ARGs (n = 19) from human and wastewater (n= 1) samples in Southeast Asia. Studies with fewer than five MRSA isolates were excluded from the meta-analysis. Results: Using random-effects meta-analysis, ST239 was the most prevalent MRSA sequence type in Southeast Asia (12.07%; 95% CI: 3.37–35.07) followed by ST22 (2.25%; 95% CI: 0.43–11.03) and ST30 (0.29%; 95% CI: 0.29-0.29) SCCmec type IV was the most common (35.57%; 95% CI: 14.24–64.73), with types III and V also frequently reported. Among antimicrobial resistance genes, mecA and blaZ were consistently present, while ermC (7.12%; 95% CI: 1.71–25.25), tetK (4.8%; 95% CI: 0.94–21.09), and aminoglycoside-resistance gene aac (8.06%; 95% CI: 1.47–33.93) showed emerging prevalence. Conclusion: SCCmec type IV (35.57%) was the most prevalent, while ST239 (12.07%) dominated as the major lineage. Rising diversity of CA-MRSA and resistance genes such as ermC, tetK, and aaC, along with limited genomic data from wastewater sources, underscores the urgent need for region-wide genomic surveillance and targeted control strategies. | ||||
| Keywords | ||||
| Methicillin-resistant Staphylococcus aureus; Southeast Asia; antibiotic resistance; Strain type; wastewater MRSA | ||||
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