Impact of methicillin resistance on mortality in Staphylococcus aureus endocarditis: a systematic review and meta-analysis
- 1Division of Infectious Diseases (Department of General Medicine), All India Institute of Medical Sciences
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a leading cause of endocarditis with poor outcomes. The magnitude and consistency of its mortality risk compared with methicillin-susceptible S. aureus (MSSA) remain uncertain. Methods Data were extracted from PubMed, Embase, Scopus, and Cochrane Library from database inception to 30 November 2025, without language restrictions. A random-effects model (Restricted Maximum-Likelihood) was used to calculate pooled risk ratios (RRs). Heterogeneity was explored by stratified and meta-regression analyses. Publication bias was assessed using funnel plot symmetry and Egger’s regression. Results Twenty-four studies, comprising 3291 patients (1,011 with MRSA and 2280 with MSSA), met the inclusion criteria. Pooled short-term mortality was significantly higher in MRSA endocarditis (30.9% vs 25.6%; RR 1.48, 95% CI 1.21-1.80; I² = 34%). Across stratified analyses by study design, setting, region, and study era, mortality remained consistently higher in MRSA endocarditis. No significant differences were found for heart failure (RR 1.08, 95% CI 0.90-1.30), embolic events (RR 0.82, 95% CI 0.51-1.33), stroke (RR 0.88, 95% CI 0.78-1.00), or surgery performed (RR 0.97, 95% CI 0.56-1.68) in MRSA and MSSA groups. No publication bias was revealed by Funnel-plot inspection and Egger’s test (p = 0.082). Meta-regression showed no effect modification by age, hospital-acquired infection, prosthetic valve, or right-sided endocarditis. Conclusions MRSA endocarditis carries a significantly higher short-term mortality than MSSA, consistent across study designs and study-level characteristics. The major complications were comparable between the two groups.
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BibTeX
@article{meena2026impact,
title = {{Impact of methicillin resistance on mortality in Staphylococcus aureus endocarditis: a systematic review and meta-analysis}},
author = {Durga Shankar Meena and Deepak Kumar and Gopal Krishana Bohra},
journal = {Communications Medicine},
year = {2026},
month = jun,
doi = {10.1038/s43856-026-01746-9},
url = {https://doi.org/10.1038/s43856-026-01746-9},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of methicillin resistance on mortality in Staphylococcus aureus endocarditis: a systematic review and meta-analysis
AU - Durga Shankar Meena
AU - Deepak Kumar
AU - Gopal Krishana Bohra
PY - 2026
DA - 2026/06/01
JO - Communications Medicine
DO - 10.1038/s43856-026-01746-9
UR - https://doi.org/10.1038/s43856-026-01746-9
AB - Background Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a leading cause of endocarditis with poor outcomes. The magnitude and consistency of its mortality risk compared with methicillin-susceptible S. aureus (MSSA) remain uncertain. Methods Data were extracted from PubMed, Embase, Scopus, and Cochrane Library from database inception to 30 November 2025, without language restrictions. A random-effects model (Restricted Maximum-Likelihood) was used to calculate pooled risk ratios (RRs). Heterogeneity was explored by stratified and meta-regression analyses. Publication bias was assessed using funnel plot symmetry and Egger’s regression. Results Twenty-four studies, comprising 3291 patients (1,011 with MRSA and 2280 with MSSA), met the inclusion criteria. Pooled short-term mortality was significantly higher in MRSA endocarditis (30.9% vs 25.6%; RR 1.48, 95% CI 1.21-1.80; I² = 34%). Across stratified analyses by study design, setting, region, and study era, mortality remained consistently higher in MRSA endocarditis. No significant differences were found for heart failure (RR 1.08, 95% CI 0.90-1.30), embolic events (RR 0.82, 95% CI 0.51-1.33), stroke (RR 0.88, 95% CI 0.78-1.00), or surgery performed (RR 0.97, 95% CI 0.56-1.68) in MRSA and MSSA groups. No publication bias was revealed by Funnel-plot inspection and Egger’s test (p = 0.082). Meta-regression showed no effect modification by age, hospital-acquired infection, prosthetic valve, or right-sided endocarditis. Conclusions MRSA endocarditis carries a significantly higher short-term mortality than MSSA, consistent across study designs and study-level characteristics. The major complications were comparable between the two groups.
SN - 2730-664X
ER -