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Review
. 2023 May 25:16:3271-3292.
doi: 10.2147/IDR.S412308. eCollection 2023.

Progress in the Prevalence, Classification and Drug Resistance Mechanisms of Methicillin-Resistant Staphylococcus aureus

Affiliations
Review

Progress in the Prevalence, Classification and Drug Resistance Mechanisms of Methicillin-Resistant Staphylococcus aureus

Zhuru Hou et al. Infect Drug Resist. .

Abstract

Staphylococcus aureus is a common human pathogen with a variety of virulence factors, which can cause multiple infectious diseases. In recent decades, due to the constant evolution and the abuse of antibiotics, Staphylococcus aureus was becoming more resistant, the infection rate of MRSA remained high, and clinical treatment of MRSA became more difficult. The genetic diversity of MRSA was mainly represented by the continuous emergence of epidemic strains, resulting in the constant changes of epidemic clones. Different classes of MRSA resulted in different epidemics and resistance characteristics, which could affect the clinical symptoms and treatments. MRSA had also spread from traditional hospitals to community and livestock environments, and the new clones established a relationship between animals and humans, promoting further evolution of MRSA. Since the resistance mechanism of MRSA is very complex, it is important to clarify these resistance mechanisms at the molecular level for the treatment of infectious diseases. We firstly described the diversity of SCCmec elements, and discussed the types of SCCmec, its drug resistance mechanisms and expression regulations. Then, we described how the vanA operon makes Staphylococcus aureus resistant to vancomycin and its expression regulation. Finally, a brief introduction was given to the drug resistance mechanisms of biofilms and efflux pump systems. Analyzing the resistance mechanism of MRSA can help study new anti-infective drugs and alleviate the evolution of MRSA. At the end of the review, we summarized the treatment strategies for MRSA infection, including antibiotics, anti-biofilm agents and efflux pump inhibitors. To sum up, here we reviewed the epidemic characteristics of Staphylococcus aureus, summarized its classifications, drug resistance mechanisms of MRSA (SCCmec element, vanA operon, biofilm and active efflux pump system) and novel therapy strategies, so as to provide a theoretical basis for the treatment of MRSA infection.

Keywords: MRSA; SCCmec; biofilm; efflux pump; prevalence; resistance mechanism.

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Conflict of interest statement

The authors declare no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Evolution of drug resistance in S. aureus. As the antibiotic resistance of S. aureus evolved, so did epidemic typing. There had been several significant changes in epidemic typing around the whole world. In the 1950s, the epidemic typing was phage type 80/81; in 1960–1970s, it evolved into phage type 83A; in the 1980s, it evolved into five major epidemic typing CC8, CC5, CC30, CC45, and CC22.
Figure 2
Figure 2
Prevalence and epidemic typing of MRSA in China. (A) The infection rate of MRSA in China (2014–2020). (B) The epidemic typing in some provinces of China over the past five years.
Figure 3
Figure 3
The structure of mec gene complex.
Figure 4
Figure 4
vanA operon and VanSR two-component transduction system. (A) When vancomycin exists, VanS autophosphorylates and activates VanR, thereby activates the expression of vanA operon. (B) vanA operon.
Figure 5
Figure 5
The model of efflux pump family.

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References

    1. Kwiecinski JM, Horswill AR. Staphylococcus aureus bloodstream infections: pathogenesis and regulatory mechanisms. Curr Opin Microbiol. 2020;53:51–60. doi:10.1016/j.mib.2020.02.005 - DOI - PMC - PubMed
    1. Humphries R, Bobenchik AM, Hindler JA, Schuetz AN. Overview of changes to the clinical and laboratory standards institute performance standards for antimicrobial susceptibility testing, M100, 31st edition. J Clin Microbiol. 2021;59(12):e0021321. doi:10.1128/JCM.00213-21 - DOI - PMC - PubMed
    1. Borg MA, Camilleri L. What is driving the epidemiology of methicillin-resistant Staphylococcus aureus infections in Europe? Microb Drug Resist. 2021;27(7):889–894. doi:10.1089/mdr.2020.0259 - DOI - PubMed
    1. Bai AD, Lo CK, Komorowski AS, et al. Staphylococcus aureus bacteremia mortality across country income groups: a secondary analysis of a systematic review. Int J Infect Dis. 2022;122:405–411. doi:10.1016/j.ijid.2022.06.026 - DOI - PubMed
    1. Lakhundi S, Zhang K. Methicillin-resistant Staphylococcus aureus: molecular characterization, evolution, and epidemiology. Clin Microbiol Rev. 2018;31(4):e00020–00018. doi:10.1128/CMR.00020-18 - DOI - PMC - PubMed

Grants and funding

This study was supported by Fundamental Research Program of Shanxi Province (Grant no. 20210302123397; 202203021212351), Key R&D Projects of Introducing High-Level Scientific and Technological Talents in Lvliang City (Grant no. 2021RC-1-4), the Project of Lvliang City Science and Technology Program (Grant no. 2020SHFZ29), Science and Technology Innovation Project of Colleges and Universities in Shanxi Province (Grant no. 2020L0749), the National College Students’ Innovation and Entrepreneurship Training Program (Grant no. 20221569), the Key Projects of Innovation and Entrepreneurship Training for College Students in Shanxi Province (Grant no. 20221577), Projects of Innovation and Entrepreneurship Training Program for College Students of Fenyang College of Shanxi Medical University (Grant no. FDC202209; FDC202214; FDC202215), and Special Fund for Key Disciplines of Fenyang College of Shanxi Medical University (Grant no. 2022B14).