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Methicillin-resistant Staphylococcus aureus

Nature Reviews Disease Primers volume 4, Article number: 18033 (2018) | Download Citation

Abstract

Since the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has emerged, disseminated globally and become a leading cause of bacterial infections in both health-care and community settings. However, there is marked geographical variation in MRSA burden owing to several factors, including differences in local infection control practices and pathogen-specific characteristics of the circulating clones. Different MRSA clones have resulted from the independent acquisition of staphylococcal cassette chromosome mec (SCCmec), which contains genes encoding proteins that render the bacterium resistant to most β-lactam antibiotics (such as methicillin), by several S. aureus clones. The success of MRSA is a consequence of the extensive arsenal of virulence factors produced by S. aureus combined with β-lactam resistance and, for most clones, resistance to other antibiotic classes. Clinical manifestations of MRSA range from asymptomatic colonization of the nasal mucosa to mild skin and soft tissue infections to fulminant invasive disease with high mortality. Although treatment options for MRSA are limited, several new antimicrobials are under development. An understanding of colonization dynamics, routes of transmission, risk factors for progression to infection and conditions that promote the emergence of resistance will enable optimization of strategies to effectively control MRSA. Vaccine candidates are also under development and could become an effective prevention measure.

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Acknowledgements

H.d.L. thanks A. Tomasz and C. Milheiriço for helpful discussions while preparing the manuscript. H.d.L.'s research is supported by Project LISBOA-01-0145-FEDER-007660 funded by the European Regional Development Fund through COMPETE2020 (POCI) and by national funds through Fundação para a Ciência e Tecnologia. A.P. thanks S. Heilbronner for helpful discussions and critical reading of the manuscript. A.P.'s research is supported by grants from the Deutsche Forschungsgemeinschaft (TRR34, TRR156, SFB766, SFB685, GRK1708 and PE805/5-1), the Deutsches Zentrum für Infektionsforschung (TTU HAARBI) and the European Innovative Medicines Initiative (COMBACTE). S.H. receives financial support from COMBACTE.

Author information

Affiliations

  1. Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

    • Andie S. Lee
  2. Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.

    • Andie S. Lee
  3. Laboratory of Microbiology and Infectious Diseases, The Rockefeller University, New York, NY, USA.

    • Hermínia de Lencastre
  4. Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal.

    • Hermínia de Lencastre
  5. Department of Medicine, Hospital Universitari Mutua de Terrassa, Barcelona, Spain.

    • Javier Garau
  6. Department of Infection Control, Amphia Hospital, Breda, Netherlands.

    • Jan Kluytmans
  7. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.

    • Jan Kluytmans
  8. Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Universiteit Antwerpen, Wilrijk, Belgium.

    • Surbhi Malhotra-Kumar
  9. Interfaculty Institute of Microbiology and Infection Medicine, Infection Biology Department, University of Tübingen, Tübingen, Germany.

    • Andreas Peschel
  10. German Center for Infection Research, Partner Site Tübingen, Tübingen, Germany.

    • Andreas Peschel
  11. Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, WHO Collaborating Center, Geneva, Switzerland.

    • Stephan Harbarth

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Contributions

Introduction (A.S.L.); Epidemiology (A.S.L. and S.H.); Mechanisms/pathophysiology (H.d.L., S.M.-K., J.K. and A.P.); Diagnosis, screening and prevention (A.S.L., S.M.-K. and S.H.); Management (J.K., S.H. and J.G.); Quality of life (S.H.); Outlook (A.P. and S.H.); Overview of Primer (S.H. and A.S.L.).

Competing interests

J.G. has acted as a consultant for Roche, Nabriva, Paratek and Menarini. J.K. acts as a consultant for Pfizer, 3M and Destiny Pharma. S.M.-K. has received grants from Abbott and Agfa Health. She is receiving research grants from Pfizer and Huvepharma and has a service agreement with AiCuris. A.P. receives a consultant fee from Crucell and research grants from Crucell, Medimmune, MorphoSys and Roche; he has a patent pending for lugdunin. S.H. was a temporary member of the speakers’ bureau for Takeda; has participated in the scientific advisory boards of DNA Electronics, Sandoz, GlaxoSmithKline and Bayer; and has received financial support for research activities from Pfizer and B. Braun. A.S.L. and H.d.L. declare no conflicts of interest.

Corresponding authors

Correspondence to Andie S. Lee or Stephan Harbarth.

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DOI

https://doi.org/10.1038/nrdp.2018.33