Comparison Between Cucurbita pepo L. Extract Alone, Mupirocin Antibiotic Alone, and Their Synergistic Effects for Nasal Staphylococcus Control: A Systematic Meta-analysis

Abstract

The increasing prevalence of mupirocin-resistant Staphylococcus strains among nasal carriers presents a growing clinical challenge, particularly in healthcare settings where nasal colonization facilitates the transmission of postoperative and device-associated infections. As conventional decolonization strategies become less effective, adjunctive therapies derived from natural sources increasing prevalence. Cucurbita pepo (pumpkin), recognized for its antimicrobial phytochemicals, may enhance the efficacy of mupirocin. This systematic meta-analysis aimed to assess the synergistic antibacterial activity of C. pepo extract in combination with mupirocin against Staphylococcus aureus and coagulase-negative staphylococci (CoNS) isolates obtained from nasal carriers. A comprehensive literature search of PubMed, Scopus, Web of Science, and Google Scholar identified nine in vitro studies published between 2005 and 2024. These studies collectively involved 368 clinical isolates, comprising Methicillin susceptible Staphylococcus aureus (MSSA), Methicillin resistant Staphylococcus aureus (MRSA), and CoNS). Extracted data on minimum inhibitory concentrations (MICs) and zones of inhibition (ZOIs) were extracted and analyzed using a random-effects model. The combination of C. pepo extract with mupirocin significantly enhanced antibacterial activity, evidenced by 2–4-fold reduction in MIC values and a 4.2 mm increase in mean ZOIs (P<0.01). The meta-analysis demonstrated a strong synergistic effect, quantified by a standardized mean difference of 1.21 (95% CI: 0.88–1.53; P<0.001) for ZOI and –1.03 (95% CI: –1.44 to –0.62; P<0.001) for MIC, with a moderate degree of heterogeneity (I²=46.7%). These findings suggest that C. pepo extract may serve as a promising adjunct in nasal decolonization protocols, particularly within contexts of mupirocin resistance. Further animal and clinical studies are needed to establish its safety, clinical efficacy, and optimal application.

Keywords: Cucurbita pepo, Minimum inhibitory concentration, Mupirocin, Staphylococcus aureus, Synergistic effect