Prevalence of vancomycin-intermediate Staphylococcus aureus among clinical isolates in Iran: A systematic review and meta-analysis

Abstract Objectives Vancomycin-intermediate Staphylococcus aureus (VISA) strains have been reported in many countries around the world and their prevalence is increasing. The incidence of these strains in Iran has been reported in some studies, however there is no overall estimation of the VISA incidence in Iran. The objective of this systematic review was to estimate the total prevalence of VISA strains reported from Iran. Methods A systematic literature review of relevant articles published on ‘ S. aureus isolates with intermediate resistance to vancomycin in Iran’ was performed in PubMed and Scopus databases in the period 2010–2017. Results From 335 records found in the electronic search, 40 related studies were included in the current analysis. This systematic review indicated that the overall prevalence rate of VISA was 0.09% [95% confidence interval (CI) 0.00–0.20] in Iran in 2010–2017. In the classification of VISA based on location, the highest frequency was in Mazandaran Province at 8.36% (95% CI 0.00–18.49%). The most prevalent VISA genotypes in Iran were staphylococcal cassette chromosome mec (SCC mec ) type III, accessory gene regulator ( agr ) group II, sequence type 22 (ST22) and staphylococcal protein A ( spa ) type t790. Conclusions Regarding the upward trend in the incidence of VISA strains in Iran and the importance of preventing VISA in public health, it is recommended to control nosocomial infections and to be cautious in the use of vancomycin.