Abstract
The rise of mupirocin-resistant Staphylococcus strains among nasal carriers presents a growing clinical challenge, particularly in healthcare settings where nasal colonization contributes to the transmission of postoperative and device-associated infections. As conventional decolonization strategies lose effectiveness, there is increasing interest in adjunctive therapies derived from natural sources. Cucurbita pepo (pumpkin), known for its antimicrobial phytochemicals, may enhance the efficacy of mupirocin. This meta-analysis was carried out to assess the synergistic antibacterial activity of C. pepo extract combined with mupirocin against Staphylococcus aureus (S.aureus) and coagulase-negative staphylococci (CoNS) isolated from nasal carriers. A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar identified nine in vitro studies published between 2005 and 2024, involving a total of 368 clinical isolates (Methicillin susceptible Staphylococcus aureus (MSSA), Methicillin resistant Staphylococcus aureus (MRSA), and coagulase negative Staphylococci (CoNS)). 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, reducing MIC values by 2–4-fold and increasing mean ZOIs by 4.2 mm (p < 0.01). Meta-analysis demonstrated a strong synergistic effect, with an SMD 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 moderate heterogeneity (I² = 46.7%). These findings suggest that C. pepo extract may serve as a promising adjunct in nasal decolonization protocols, especially in cases involving mupirocin resistance. Additional animal and clinical studies are required to establish safety, efficacy, and best clinical application.