Abstract
Staphylococcus aureus is a pathogen commonly found in nosocomial environments where infections can easily spread - especially given the reduced immune response of patients and large overlap between personnel in charge of their care. Although antibiotics are available to treat nosocomial infections, the increased occurrence of antibiotic resistance has rendered many treatments ineffective. Such is the case for methicillin resistant S. aureus (MRSA), which has continued to be a threat to public health since its emergence. For this reason, alternative treatment technologies utilizing antimicrobials such as bacteriocins, bacteriophages (phages) and phage endolysins are being developed. These antimicrobials provide an advantage over antibiotics in that many have narrow inhibition spectra, enabling treatments to be selected based on the target (pathogenic) bacterium while allowing for survival of commensal bacteria and thus avoiding collateral damage to the microbiome. Bacterial resistance to these treatments occurs less frequently than with antibiotics, particularly in circumstances where combinatory antimicrobial therapies are used. Phage therapy has been well established in Eastern Europe as an effective treatment against bacterial infections. While there are no Randomized Clinical Trials (RCTs) to our knowledge examining phage treatment of S. aureus infections that have completed all trial phases, numerous clinical trials are underway, and several commercial phage preparations are currently available to treat S. aureus infections. Bacteriocins have primarily been used in the food industry for bio-preservation applications. However, the idea of repurposing bacteriocins for human health is an attractive one considering their efficacy against many bacterial pathogens. There are concerns about the ability of bacteriocins to survive the gastrointestinal tract given their proteinaceous nature, however, this obstacle may be overcome by altering the administration route of the therapy through encapsulation, or by bioengineering protease-resistant variants. Obstacles such as enzymatic digestion are less of an issue for topical/local administration, for example, application to the surface of the skin. Bacteriocins have also shown impressive synergistic effects when used in conjunction with other antimicrobials, including antibiotics, which may allow antibiotic-based therapies to be used more sparingly with less resistance development. This review provides an updated account of known bacteriocins, phages and phage endolysins which have demonstrated an impressive ability to kill S. aureus strains. In particular, examples of antimicrobials with the ability to target MRSA strains and their subsequent use in a clinical setting are outlined.
Highlights
The current COVID-19 pandemic has revealed just how vulnerable humankind is to infectious agents where natural selection and mutations give rise to new pathogens for which we have few to no therapeutic solutions
Staphylococcus aureus infections continue to be a challenge in hospital settings, methicillin resistant S. aureus (MRSA)
New antibiotics are not being developed fast enough to counteract the antibiotic resistance crisis, with several existing antibiotics becoming ineffective in clinical practice (Field et al, 2016)
Summary
The current COVID-19 pandemic has revealed just how vulnerable humankind is to infectious agents where natural selection and mutations give rise to new pathogens for which we have few to no therapeutic solutions. Ointment containing the antibiotic mupirocin is commonly used to eradicate staphylococcal nasal carriage While this type of therapeutic has been shown as an effective form of prevention and treatment, resistance does develop (Fenton et al, 2010a). S. aureus infections, including those of MRSA, are one of the main causative agents of mastitis, both in human and bovine populations (Field et al, 2016). Is this a threat to the health of humans and lactating animals but it affects the quality of milk produced while increasing the burden of costs and care in both cases. The virulence and antibiotic resistance traits of S. aureus are governed by genes present on its circular chromosome
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