Staphylococcus aureus nasal decolonization strategies: a review

Area of Science:

• Microbiology and Infectious Diseases
• Pharmacology and Therapeutics
• Antimicrobial Resistance

Background:

• Staphylococcus aureus (S. aureus) infections cause significant morbidity and mortality.
• Persistent nasal carriage of S. aureus (10-30% of population) is a major risk factor.
• Nasal decolonization is a key strategy to mitigate S. aureus infection risk.

Purpose of the Study:

• To review mupirocin's efficacy, resistance, and explore alternative nasal decolonization agents.
• To discuss agents under investigation for S. aureus nasal decolonization.
• To highlight the need for novel strategies to combat rising mupirocin resistance.

Main Methods:

• Literature review of mupirocin efficacy and resistance studies.
• Survey of existing and novel decolonization agents.
• Analysis of preclinical and clinical trial data for alternative agents.

Main Results:

• Mupirocin is effective but faces increasing resistance.
• Several alternative agents, including antiseptics, antibiotics, and novel compounds, are under investigation.
• Some alternatives show promise in preclinical or early clinical stages.

Conclusions:

• Rising mupirocin resistance necessitates the development of alternative decolonization agents.
• Further research is crucial for agents like chlorhexidine, rifampicin, and novel compounds (e.g., LTX-109, phages).
• Focus on single-dose strategies and agents that minimize resistance selection is recommended.