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Published on: May 8, 2013
Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococci (VRE) in Nosocomial
Peptine Lucian-Daniel1,2, Zaharia Andreea-Eliza1,2, Maftei Nicoleta-Maricica1,2
1Dunarea de Jos University of Galati, Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, 800008 Galati, Romania.
Abstract:
Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) are high-burden healthcare-associated pathogens that increase mortality, prolong hospitalisation, and drive substantial healthcare costs worldwide. These infections are associated with high morbidity, increased mortality, prolonged hospital stays, and significant costs, particularly among immunocompromised patients or those with extended hospitalizations. This systematic review was conducted and reported in accordance with PRISMA 2020, aiming to synthesise existing data on the epidemiology, resistance mechanisms, clinical manifestations, and strategies for the diagnosis, treatment, and prevention of MRSA and VRE infections. Data were qualitatively synthesised. A total of 113 records published between 2020 and 2025 met the inclusion criteria and were identified through searches in multiple bibliographic databases and publisher platforms (e.g., PubMed, Scopus, Web of Science). MRSA and VRE are implicated in numerous severe infections, including ventilator-associated pneumonia, catheter-associated urinary tract infections, endocarditis, and bacteraemia. Antimicrobial resistance is driven by the mecA, vanA, and vanB genes, while biofilm formation further complicates therapeutic efforts. Biofilm formation can promote antibiotic tolerance (slower killing without an increase in MIC) and persistence (survival of 'persister' cells), distinct from genetic resistance, and may complicate therapy in selected infections. Effective strategies include appropriate anti-MRSA/anti-VRE agents (e.g., ceftaroline for MRSA; linezolid or daptomycin for VRE), active screening, stringent infection prevention and control measures, and antimicrobial stewardship programmes. Implementation is often hindered by institutional barriers, limited resources, and insufficient staff training. A multidisciplinary, evidence-based approach is essential for the effective management of these infections. Reducing this burden requires coordinated implementation of rapid diagnostics, stringent infection prevention and control, and antimicrobial stewardship, supported by sustained institutional and public health investment.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) cause severe infections. Effective management requires diagnostics, infection control, and antimicrobial stewardship.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Healthcare-associated infections (HAIs) caused by MRSA and VRE pose significant global health challenges.
- These pathogens are linked to increased mortality, prolonged hospital stays, and substantial healthcare costs.
- Vulnerable populations, including immunocompromised patients, face higher risks.
Purpose of the Study:
- To systematically review and synthesize current data on MRSA and VRE infections.
- To cover epidemiology, resistance mechanisms, clinical features, and management strategies.
- To identify challenges and essential components for effective control.
Main Methods:
- Systematic review conducted according to PRISMA 2020 guidelines.
- Qualitative synthesis of data from 113 records published between 2020-2025.
- Searches across major bibliographic databases (PubMed, Scopus, Web of Science).
Main Results:
- MRSA and VRE are implicated in severe infections like VAP, CAUTI, endocarditis, and bacteremia.
- Antimicrobial resistance is associated with mecA, vanA, and vanB genes; biofilm formation complicates treatment.
- Effective strategies include specific antimicrobial agents, active screening, IPC, and stewardship programs.
Conclusions:
- Managing MRSA and VRE necessitates a multidisciplinary, evidence-based approach.
- Overcoming barriers like limited resources and training is crucial for implementation.
- Coordinated efforts in diagnostics, IPC, and stewardship, supported by investment, are vital to reduce the burden.
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