Samaneh Shahrokh Esfahani - Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Aliye Tabatabaee - Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Mojtaba Akbari, - Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Ashraf Aminorroaya, - Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Mansour Siavash - Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Introduction: Diabetic foot ulcers have adverse effects on the quality of life of affected individuals and burden not only the patients but also the health care system. S. aureus is a frequent leading cause of grave diabetic foot infections (DFIs) with high morbidity, mortality, and healthcare-associated costs. It has various virulence factors including membrane-damaging peptides, exfoliative toxins, enterotoxins, toxin shock syndrome toxin 1, and epidermal cell differentiation inhibitors toxins. This study aimed to measure the frequency of membrane-damaging peptide genes (including hla, hlb, hld, hlg, hlgv, hlgA lukSF, lukDE) in S.aureus isolates from DFI.Methods: We searched PubMed, Embase, Web of Science, and Scopus for cross-sectional studies that measured at least one component of membrane-damaging peptide gene in S. aureus isolated from diabetic foot infections. The study procedure was carried out by two authors independently. Data on general information, baseline characteristics of the participants, and outcomes of interest were extracted from the eligible studies. Results: Of 171 retrieved articles, 12 evaluated membrane-damaging peptide genes and entered the study. A total of 959 S. aureus isolates were obtained from 1699 DFIs. Among the membrane-damaging peptide genes, hld 97.8% (95% CI: 83.9, 99.7) and hlg 94.6% (95% CI: 60.7, 99.5) have the most and luk-SF (PVL) 6.6% (95% CI: 20, 28%) the least frequency in S. aureus isolated from DFIs.Conclusion: Since S. aureus is the predominant pathogen isolated from DFIs, knowing the most frequent virulence factors may help to control this pathogen efficiently. This systematic review and meta-analysis revealed that δ-hemolysin and γ-hemolysin were the most frequent membrane-damaging peptides found in S.aureus isolated from DFIs.