Pathogenesis of MRSA-influenza co-infection: implications for ECMO therapeutic strategies - a mini-review

Influenza virus (Influenzavirus A) and Staphylococcus aureus (S. aureus) co-infection is a critical clinical challenge, often leading to severe complications such as necrotizing pneumonia. This review elucidates the mechanisms by which influenza virus facilitates S. aureus infections through epithelial damage and immune modulation, thereby exacerbating pulmonary injury. Specifically, influenza virus infection damages respiratory epithelial cells and disrupts the integrity of the lung barrier. This process facilitates the invasion of S. aureus, which produces various virulence factors, including Panton-Valentine leukocidin (PVL) and phenol-soluble modulins (PSMs), leading to enhanced inflammation and tissue destruction. Furthermore, methicillin-resistant S. aureus (MRSA) strains are associated with higher morbidity and mortality due to their resistance to beta-lactam antibiotics and increased toxin production. Understanding the interplay between influenza virus-induced epithelial damage and S. aureus toxin-mediated immune responses is crucial for developing effective therapeutic interventions to mitigate the severity of necrotizing pneumonia. This review also explores the potential roles of adjunctive therapies, such as extracorporeal membrane oxygenation (ECMO) and novel agents like intravenous immunoglobulin (IVIG) and N-acetylcysteine (NAC), in redefining treatment paradigms for these severe infections.