Global prevalence and antimicrobial resistance of Staphylococcus aureus isolates from patients with musculoskeletal infections: a systematic review and meta-analysis.

BACKGROUND

Staphylococcus aureus is the most prevalent and destructive pathogen among musculoskeletal infections. Understanding of the incidence and antibiotic resistance of S.aureus infection can inform investments in prevention and treatment interventions.

MATERIALS AND

METHODS

We searched PubMed, Embase, Web of Science, and the Cochrane Database for studies published up to 11 June 2025. Forward and backward citation of included studies was also conducted. Studies were included if they involved participants diagnosed with musculoskeletal infections and reported the prevalence or/and antibiotic resistance of S. aureus. Heterogeneity was assessed by I2 and 95% prediction intervals. A funnel plot was created to evaluate publication bias. For pooled effect estimates, we used random-effects models. This study was registered with PROSPERO.

RESULTS

A total of 122 studies (57 659 participants) were included. The pooled incidence of S. aureus infection was 33% [95% confidence interval (CI), 30%-36%], and the proportion of Methicillin-resistant S. aureus to S. aureus was 33% (95% CI, 27%-39%). The pooled antibiotic resistance rate of S. aureus was 43% for erythromycin (95% CI, 26%-61%), 25% for clindamycin (95% CI, 13%-39%), 83% for penicillin (95% CI, 64%-96%), 34% for gentamicin (95% CI, 18%-52%), 1% for vancomycin (95% CI, 0%-5%), 30% for levofloxacin (95% CI, 17%-44%), and 14% for rifampicin (95% CI, 5%-26%). S. aureus infection rates varied significantly among continents, study periods, and disease types. Limitations of this study include considerable heterogeneity among the studies and insufficient data from some countries.

CONCLUSION

Musculoskeletal S. aureus infections impose a large burden on health care systems. Future research should prioritize standardized global surveillance, filling epidemiological gaps in underrepresented areas, and developing novel therapeutic strategies to combat the evolving challenge of antimicrobial resistance in S. aureus musculoskeletal infections. Collective efforts are, therefore, urgently needed to translate this evidence into effective prevention, targeted treatment, and robust stewardship protocols to mitigate this persistent threat.