Abstract
Staphylococcus aureus is the most common pathogen of wound infections. Thus far, methicillin-resistant S. aureus (MRSA) has become the major causative agent in wound infections, especially for nosocomial infections. MRSA infections are seldom eradicated by routine antimicrobial therapies. More concerning, some strains have become resistant to the newest antibiotics of last resort. Furthermore, horizontal transfer of a polymyxin resistance gene, mcr-1, has been identified in Enterobacteriaceae, by which resistance to the last group of antibiotics will likely spread rapidly. The worst-case scenario, “a return to the pre-antibiotic era”, is likely in sight. A perpetual goal for antibiotic research is the discovery of an antibiotic that lacks resistance potential, such as the recent discovery of teixobactin. However, when considering the issue from an ecological and evolutionary standpoint, it is evident that it is insufficient to solve the antibiotic dilemma through the use of antibiotics themselves. In this review, we summarized recent advances in antibiotic-based, antibiotic-free and ethnomedical treatments against MRSA wound infections to identify new clues to solve the antibiotic dilemma. One potential solution is to use ethnomedical drugs topically. Some ethnomedical drugs have been demonstrated to be effective antimicrobials against MRSA. A decline in antibiotic resistance can therefore be expected, as has been demonstrated when antibiotic-free treatments were used to limit the use of antibiotics. It is also anticipated that these drugs will have low resistance potential, although there is only minimal evidence to support this claim to date. More clinical trials and animal tests should be conducted on this topic.
Highlights
Staphylococcus aureus is the most common pathogen involved in skin and soft tissue infections and is the principal cause of surgical site infections (SSI) [1,2]
Silver is generally accepted as an evidence-based topical wound antimicrobial that is used as a preparation of either a solution or nanoparticles in wound dressings [148,149]; silver is suggested to treat Gbacteria more effectively, whereas mupirocin is the recommendation for methicillin-resistant S. aureus (MRSA) wound infection [154]
The topical use of ethnomedical drugs represents both the development of new wound dressings as well as a platform to study ethnomedical drugs in a “treat it as a whole” approach, which improves the translation of ethnomedicine into evidence-based practice
Summary
Staphylococcus aureus is the most common pathogen involved in skin and soft tissue infections and is the principal cause of surgical site infections (SSI) [1,2]. Colonized staphylococcal cells are potential sources for cross-contamination, whereby S. aureus becomes a major nosocomial pathogen. Nosocomial infection is a major cause of surgical morbidity and mortality [3,4], and SSIs have a reported incidence rate of 2%–20% [5,6]. The major cause of nosocomial infection is methicillin-resistant S. aureus (MRSA) [8,9,10], which is hard to eradicate [7] despite reports of some cases treated by warming therapy [4]. The efficacy of eradication in patients with community-associated MRSA has not been established, and the necessity of routine decolonization is not supported by data [7]. Effective therapeutic options to combat S. aureus infection, with an emphasis on MRSA, are urgently needed
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