Methicillin-Resistant Staphylococcus aureus (MRSA), Vancomycin-Resistant Staphylococcus aureus (VRSA), and Vancomycin-Resistant Enterococci‌ (VRE) Contamination of Food Samples in Iran: A Systematic Review and Meta-Analysis

During the last years, antimicrobial resistance has become one of the greatest challenges in clinical settings. Staphylococcus aureus and Enterococcus are important nosocomial pathogens worldwide. In different corners of the world, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) have been isolated from various sources including different foods of animal and plant origin; however, information about food-related vancomycin-resistant Staphylococcus aureus (VRSA) is limited. The current review describes the presence of MRSA, VRSA and VRE in different food samples of animal and plant origin in Iran. Databases including PubMed, ScienceDirect, Scopus, SID, and Google Scholar were searched and a total of 65 articles were retrieved (published between 2006 and September 2020) reporting antibiotic-resistant S. aureus and Enterococcus in food in Iran. The overall prevalence meta-analysis was calculated by using “meta prop program” in STATA statistical software. Finally, 42 studies were included in the present review. These reports indicated high rates of MRSA, VRSA and VRE strains in different types of raw and processed meat, raw milk, traditional cheese, restaurant, and hospital foods. The meta-analysis showed that the highest pooled ES of MRSA was for pastry products and the lowest pooled ES of MRSA was for miscellaneous foods. Thus, higher priority should be given to the development of effective surveillance systems which can track the appropriate use of wide-spectrum antibiotics and spread of antimicrobial-resistant organisms throughout food supply chains. Future research should assess the risk of antimicrobial resistance transmission to consumers following intake of MRSA, VRSA, and VRE-contaminated foodstuffs.