Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Infect Dis. May 21, 2019; 9(1): 1-10
Published online May 21, 2019. doi: 10.5495/wjcid.v9.i1.1
Treatments and limitations for methicillin-resistant Staphylococcus aureus: A review of current literature
Rahul Kashyap, Aditya Shah, Taru Dutt, Patrick M Wieruszewski, Jaishid Ahdal, Rishi Jain
Rahul Kashyap, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55902, United States
Aditya Shah, Department of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, United States
Taru Dutt, Neurology Research, Mayo Clinic, Rochester, MN 55902, United States
Patrick M Wieruszewski, Department of Pharmacy, Critical Care Medicine, Mayo Clinic, Rochester, MN 55902, United States
Jaishid Ahdal, Rishi Jain, Workhardt Limited, Bandra East, Mumbai, Maharashtra 400051, India
Author contributions: Kashyap R, Shah A, Dutt T and Wieruszewski SM conceptualized the review; Ahdal J and Jain R performed the initial literature search and procured the required literature for the review; Kashyap R, Ahdal J and Jain R prepared the initial manuscript draft; Shah A, Dutt T and Wieruszewski SM performed initial review of the manuscript and finalized the contents; Kashyap R, Shah A, Dutt T, Wieruszewski SM, Ahdal J and Jain R individually reviewed the final draft and approved the same.
Conflict-of-interest statement: Authors Rahul Kashyap, Aditya Shah, Taru Dutt, and Patrick M. Wieruszewski have nothing to declare. Authors Jaishid Ahdal and Rishi Jain are salaried employees of the Wockhardt Ltd, BKC, Mumbai, India.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Rahul Kashyap, MBBS, Assistant Professor, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200, First Street, SW Rochester, Rochester, MN 55902, United States.
Telephone: +1-507-2557196 Fax: +1-507-2554267
Received: December 31, 2018
Peer-review started: January 3, 2019
First decision: March 15, 2019
Revised: March 29, 2019
Accepted: April 8, 2019
Article in press: April 9, 2019
Published online: May 21, 2019

Methicillin-resistant Staphylococcus aureus (MRSA) has remained a major threat to healthcare; in both hospital and community settings over the past five decades. With the current use of antibiotics for a variety of infections, including MRSA, emerging resistance is a major concern. Currently available treatments have restrictions limiting their use. These issues include, but are not limited to, side effects, cross-resistance, lack of understanding of pharmacokinetics and clinical pharmacodynamics, gradual increment in minimal inhibitory concentration over the period (MIC creep) and ineffectiveness in dealing with bacterial biofilms. Despite availability of various therapeutic options for MRSA, the clinical cure rates remain low with high morbidity and mortality. Given these challenges with existing treatments, there is a need for development of novel agents for MRSA. Along with prompt infection control strategies and strict implementation of antibiotic stewardship, cautious use of newer anti-MRSA agents will be of utmost importance. This article reviews the treatments and limitations of MRSA management and highlights the future path.

Keywords: Methicillin resistant, Methicillin-resistant Staphylococcus aureus, Antibiotics, Monotherapy

Core tip: Methicillin-resistant S. aureus (MRSA) remains a major threat despite availability of multiple treatments. Limitations of the current anti-MRSA treatments demand more careful use of these agents. Using antibiotics in combination for MRSA treatment needs further evaluation. Multiple strategies including research and development of new antibiotics and antibiotic stewardship are necessary to contain the MRSA.