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Updated: Mar 15, 2026
Development and Assessment of Intracellular Infection Models for Staphylococcus aureus
Published on: January 17, 2025
[Directed therapeutic approach to Staphylococcus aureus infections. Clinical aspects of prescription]
F Carmona-Torre, M Rua, J L Del Pozo1
1José Luis Del Pozo, Área de Enfermedades Infecciosas y Microbiología Clínica. Clínica Universidad de Navarra. Pamplona. Spain. jdelpozo@unav.es.
Abstract:
Infections caused by Staphylococcus aureus have had classically an important impact in morbidity and mortality in the nosocomial and community scene. The description of methicillin resistance among nosocomial isolates of S. aureus and his widespread diffusion has become methicillin-resistant S. aureus (MRSA) in one of the most common causes of bacterial nosocomial infections. In the last years MRSA strains have also emergence in the community. This together with a progressive increase in resistance to antibiotics used classically has become vancomycin in the treatment of choice in most cases according to clinical guidelines. As a result, a progressive rise in the minimum inhibitory concentration (MIC) to vancomycin has been reported. In this context strains with intermediate susceptibility to vancomycin (MIC 8-4 mg/L) and heteroresistance have been noted. These strains are associated with a higher risk of treatment failure when using vancomycin. Among isolates of S. aureus susceptible to vancomycin there has been described stains with elevated MICs (≥1.5 mg/L). It is controversial if the presence of these strains has an impact on clinical outcome if treatment with vancomycin or β-lactams is prescribed. The development of new antibiotics with activity against MRSA and exploring synergies offer a promising alternative to treatment with vancomycin.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) infections are rising, leading to increased vancomycin use. Emerging vancomycin resistance and heteroresistance in MRSA strains pose treatment challenges, necessitating new antibiotic development.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Staphylococcus aureus infections significantly contribute to morbidity and mortality in both hospital and community settings.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial infections, with increasing community prevalence.
- Rising antibiotic resistance has made vancomycin the primary treatment, leading to increased minimum inhibitory concentrations (MICs) and emerging resistance.
Purpose of the Study:
- To review the challenges posed by vancomycin resistance and heteroresistance in MRSA infections.
- To discuss the clinical implications of elevated vancomycin MICs in susceptible S. aureus strains.
- To explore alternative treatment strategies, including new antibiotics and synergistic combinations.
Main Methods:
- Literature review of studies on MRSA, vancomycin resistance, and treatment outcomes.
- Analysis of reported trends in vancomycin MICs for S. aureus isolates.
- Evaluation of emerging resistance mechanisms and their clinical significance.
Main Results:
- Vancomycin intermediate susceptibility and heteroresistance in MRSA strains are increasing.
- These resistant strains are linked to higher rates of vancomycin treatment failure.
- Elevated vancomycin MICs (≥1.5 mg/L) in susceptible S. aureus strains may impact clinical outcomes, though this remains controversial.
Conclusions:
- The rise of vancomycin resistance and heteroresistance in MRSA necessitates urgent development of alternative therapies.
- New antibiotics and synergistic drug combinations show promise for overcoming vancomycin treatment failures.
- Further research is needed to clarify the clinical impact of elevated vancomycin MICs in susceptible strains.
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