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Updated: Aug 19, 2026

Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Methicillin-resistant staphylococci
1Medical Service, San Francisco General Hospital, California.
Abstract:
Strains of staphylococci resistant to methicillin were identified immediately after introduction of this drug. Methicillin-resistant strains have unusual properties, the most notable of which is extreme variability in expression of the resistance trait. The conditions associated with this heterogeneous expression of resistance are described. Methicillin resistance is associated with production of a unique penicillin-binding protein (PBP), 2a, which is bound and inactivated only at high concentrations of beta-lactam antibiotics. PBP2a appears to be encoded by the mec determinant, which also is unique to methicillin-resistant strains. The relationships between PBP2a and expression of resistance and implications for the mechanism of resistance are discussed. The heterogeneous expression of methicillin resistance by staphylococci poses problems in the detection of resistant strains. Experience with several susceptibility test methods is reviewed and guidelines for performance of these tests are given. Treatment of infections caused by methicillin-resistant staphylococci is discussed. Vancomycin is the treatment of choice. Alternatives have been few because methicillin-resistant strains often are resistant to multiple antibiotics in addition to beta-lactam antibiotics. New agents which are active against methicillin-resistant staphylococci are becoming available, and their potential role in treatment is discussed.
Insights
Methicillin-resistant staphylococci (MRS) exhibit variable resistance due to unique penicillin-binding protein 2a (PBP2a). Detection and treatment challenges are discussed, with vancomycin as the preferred therapy.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Methicillin-resistant staphylococci (MRS) emerged shortly after methicillin's introduction.
- These strains display significant heterogeneity in expressing resistance traits.
- This variability complicates accurate detection and treatment strategies.
Purpose of the Study:
- To describe conditions influencing heterogeneous methicillin resistance expression in staphylococci.
- To review susceptibility testing methods for MRS detection.
- To discuss current and emerging treatment options for MRS infections.
Main Methods:
- Characterization of penicillin-binding protein 2a (PBP2a) and its encoding mec determinant.
- Evaluation of various antimicrobial susceptibility testing methodologies.
- Review of clinical data on treatment outcomes for MRS infections.
Main Results:
- Methicillin resistance is linked to PBP2a production, encoded by the mec determinant.
- PBP2a is inactivated only at high beta-lactam antibiotic concentrations.
- Heterogeneous resistance expression poses significant challenges for reliable laboratory detection.
Conclusions:
- Understanding PBP2a and mec determinant is crucial for elucidating resistance mechanisms.
- Standardized susceptibility testing guidelines are essential for accurate MRS identification.
- Vancomycin remains the primary treatment, with new agents showing promise for resistant strains.
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