Current and emerging drug treatment strategies to tackle invasive community-associated methicillin-resistant Staphylococcus aureus (MRSA) infection: what are the challenges?

ABSTRACT

Introduction

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections represent a leading cause of purulent skin and soft tissue infections in some geographical regions. Traditionally, ‘old antibiotics’ such as trimethoprim-sulfamethoxazole, tetracyclines, clindamycin, chloramphenicol,vancomycin, and teicoplanin have been used to treat these infections, but these were often associated with low efficacy and excessive side effects and toxicity, especially nephrotoxicity. Along with the development of new compounds, the last decade has seen substantial improvements in the management of CA-MRSA infections.

Areas covered

In this review, the authors discuss the current and emerging drug treatment strategies to tackle invasive CA-MRSA infections. Articles reported in this review were selected from through literature searches using the PubMed database.

Expert opinion

The availability of new drugs showing a potent in vitro activity against CA-MRSA represents a unique opportunity to face the threat of resistance while potentially reducing toxicity. All these compounds represent promising options to enhance our antibiotic armamentarium. However, data regarding the use of these new drugs in real-life studies are limited and their best placement in therapy and in terms of optimization of medical resources and balance of cost-effectiveness requires further investigation.

KEYWORDS:

• MRSA
• PVL
• community-acquired
• cephalosporins
• oxazolidinones
• fluoroquinolones
• lipoglycopeptides
• tetracyclines
• lefamulin

Article highlights

• Infections from community-associated-methicillin-resistant Staphylococcus aureus (CA-MRSA) are associated high morbidity, mortality, and economic burden worldwide

• The history of exposure to the community or the healthcare environment has now poor predictive value for distinguishing CA-MRSA and HA-MRSA

• Old anti-MRSA molecules often have unpredictable activity over CA-MRSA strains. Furthermore, some of these compounds lacks solid evidence of safety and efficacy

• Combination therapy should not be routinely used

• A number of novel agents have been approved against MRSA. Major advantages of most of these compounds are the antitoxin activity, the long half-life, and the possibility to be administered in outpatient

Declaration of Interest

M. Bassetti has participated on advisory boards and/or has received speaker fees from Achaogen, Angelini, Astellas, Bayer, Basilea, Biomerieux, Cidara, Gilead Sciences, Menarini, Merck Sharp and Dohme, Nabriva, Paratek, Pfizer Inc., Roche, Melinta Therapeutics, Shionogi, Tetraphase, VenatoRx, and Vifor. He has also received study grants from Angelini, Basilea, Astellas, Shionogi, Cidara, Melinta, Gilead Sciences, Pfizer, and Merck Sharp and Dohme. A Vena meanwhile has participated on advisory boards and/or received speaker fees from Angelini, Menarini, Merck Sharp and Dohme, Pfizer, and Shionogi. HE has also received study grants from Merck Sharp and Dohme and Astellas. DR Giacobbe meanwhile has received investigator-initiated grants from Pfizer Inc, Shionogi, Gilead Italia, as well as speaker fees and/or advisory board fees from Pfizer and Tillotts Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14656566.2022.2161885

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.