Treatment advances of methicillin-resistant Staphylococcus aureus associated clinical infections

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a common clinic pathogen for nosocomial infections, such as pneumonia, bloodstream infection, endocarditis, skin soft-tissue infection, and osteoarticular infection, which brings giant challenge for clinic treatment. Vancomycin remains an acceptable treatment option, but it needs to be adjusted by pharmacokinetic/pharmacodynamic (PK/PD) parameters. Lipoglycopeptides show excellent antimicrobial activity in vitro, but their long half-lives and complex PKs may preclude these agents being used in critically ill patients. Anti-MRSA cephalosporins were reported to be associated with the emergence of its antimicrobial resistance, so clinicians should be cautious when employing these kinds of antibiotics in clinical practice. So far, only linezolid has been proved with better performance than vancomycin for the treatment of hospital acquired pneumonia due to MRSA. Tedizolid, which is also categorized as Oxazolidinone, has higher bioavailability with lower rate of adverse events, but more investigation and validation are still needed for clinic application. Daptomycin displays similar performance with vancomycin on bloodstream infection due to MRSA, so it is recommended as the main drug for the treatment of MRSA associated bloodstream infection. Others such as quinupristin/dalfopristin and tigecycline are all lack of clinical evidence on the treatment of MRSA associated severe infections, so they are only considered when other anti-MRSA drugs showing inferior clinical effects. Rifampicin, Gentamicin, Fosfomycin, Sulfamethoxazole-Trimethoprim and other drugs may be administered for combination therapy, but clinical evidence is still lacking. Key words: Staphylococcus aureus; Methicillin resistance; Anti-bacterial agents; Treatment