International Journal of Inflammation, Cancer and Integrative Therapy
Open Access

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as one of the most formidable challenges in contemporary medicine, primarily due to its capacity to evade treatment with many commonly prescribed antibiotics. This bacterium was first identified in the late 1960s as a strain resistant to methicillin, a beta-lactam antibiotic that was previously considered highly effective against Staphylococcus aureus infections. Over the decades, MRSA has evolved and diversified, leading to its widespread prevalence and establishment as a major pathogen [1].

MRSA’s resistance to methicillin and other beta-lactam antibiotics stems from the acquisition of the mecA gene, which encodes for an altered penicillin-binding protein (PBP2a). This protein reduces the efficacy of beta-lactams, rendering them ineffective in inhibiting cell wall synthesis, a crucial mechanism of these antibiotics [2]. As a result, MRSA infections cannot be treated with standard beta-lactam antibiotics, necessitating the use of alternative, often more expensive and less well-tolerated, treatments.

The impact of MRSA extends beyond its resistance to antibiotics; it is a key player in a variety of infections, particularly chronic skin diseases. Unlike infections caused by non-resistant strains of Staphylococcus aureus, MRSA infections tend to be more persistent and recurrent. This chronicity is partly due to MRSA's ability to form biofilms, protective clusters of bacteria that adhere to surfaces and are resistant to both the host immune response and antimicrobial treatments [3]. Additionally, MRSA's high rate of colonization and transmission exacerbates its role in chronic infections, creating a cycle of persistent infection and reinfection.

Chronic skin diseases associated with MRSA include conditions such as recurrent abscesses, chronic folliculitis, and severe cases of cellulitis and erysipelas. These infections often lead to significant morbidity, impacting the quality of life of affected individuals and posing substantial challenges for healthcare providers. The persistent nature of MRSA infections complicates treatment strategies, as standard therapies may fail, and the risk of complications and resistance development increases

This article delves into the role of MRSA in chronic skin diseases, providing a comprehensive overview of how this pathogen contributes to persistent and recurrent infections. It examines the mechanisms underlying MRSA's resistance to antibiotics, the impact of these infections on patients, and the implications for management and treatment. Understanding these aspects is crucial for developing effective strategies to combat MRSA and mitigate its impact on public health.

Description

Role of MRSA in chronic skin diseases

MRSA is implicated in several chronic skin conditions, characterized by persistent, recurrent, and sometimes severe infections. The bacteria’s ability to cause chronic skin diseases can be attributed to its virulence factors and resistance mechanisms:

Virulence factors: MRSA produces a range of virulence factors that contribute to its pathogenicity. These include:

Toxins: Exotoxins such as alpha-toxin, which can cause cell lysis and tissue damage.

Adhesins: Surface proteins that help MRSA adhere to skin and mucosal surfaces, facilitating persistent colonization and infection.

Biofilm formation: MRSA can form biofilms, which are communities of bacteria encased in a protective matrix. Biofilms are particularly problematic in chronic infections as they protect the bacteria from both the host immune response and antibiotic treatment.

Chronic skin conditions associated with MRSA

Chronic abscesses: MRSA can lead to the formation of chronic abscesses, which are localized collections of pus that can persist despite treatment. These abscesses often require surgical intervention for effective management.

Chronic folliculitis: This condition involves inflammation of hair follicles, leading to recurrent pustules and discomfort. MRSA’s resistance to conventional treatments makes managing chronic folliculitis challenging.

Chronic erysipelas and cellulitis: MRSA is also associated with chronic cases of erysipelas and cellulitis, conditions characterized by inflammation of the skin and underlying tissues. These chronic infections can lead to significant morbidity and require prolonged antibiotic therapy [4].

Mechanisms of resistance

Altered penicillin-binding proteins (PBPs): MRSA possesses an altered form of PBP2a, which reduces the binding efficacy of beta-lactam antibiotics, including methicillin.

Genetic factors: MRSA carries the mecA gene, which encodes for PBP2a and is responsible for methicillin resistance. This genetic trait is often carried on mobile genetic elements known as staphylococcal cassette chromosomes (SCCmec).

Implications for management and treatment

Managing MRSA-related chronic skin diseases poses several challenges:

Antibiotic resistance: The resistance of MRSA to commonly used antibiotics necessitates the use of alternative treatments, such as vancomycin, linezolid, or daptomycin. However, the effectiveness of these agents can vary, and resistance to these drugs is also emerging [5].

Infection control: Effective management includes stringent infection control measures to prevent the spread of MRSA, particularly in healthcare settings and among individuals with frequent skin infections.

Decolonization: Strategies to decolonize MRSA carriers, such as nasal mupirocin and chlorhexidine washes, can help reduce the risk of recurrent infections [6].

Conclusion

Methicillin-resistant Staphylococcus aureus (MRSA) plays a significant role in chronic skin diseases, presenting considerable challenges in both treatment and management. Its ability to cause persistent and recurrent infections, combined with its resistance to multiple antibiotics, complicates efforts to control and eradicate these conditions. Effective management of MRSA-related chronic skin diseases requires a multifaceted approach, including the use of appropriate antibiotics, rigorous infection control practices, and strategies to decolonize MRSA carriers. Continued research into new treatment options and resistance mechanisms is essential to improve outcomes and address the growing threat of MRSA in chronic skin infections.

Acknowledgement

None

Conflict of Interest

None

References

1. Hoyer KK, Kuswanto WF, Gallo E, Abbas AK (2009) Distinct roles of helper T-cell subsets in a systemic autoimmune disease. Blood 113: 389-395.

Indexed at, Google Scholar, Crossref

2. Murphy KA, Bhamidipati K, Rubin SJ, Kipp L, Robinson WH, et al. (2019) Immunomodulatory receptors are differentially expressed in B and T cell subsets relevant to autoimmune disease. Clin Immunol 209: 108276.

Indexed at, Google Scholar, Crossref

3. Kortekaas Krohn I, Aerts J L, Breckpot K, Goyvaerts C, Knol E, et al. (2022) T‐cell subsets in the skin and their role in inflammatory skin disorders. Allergy 77: 827-842.

Indexed at, Google Scholar, Crossref

4. Mason D, Fowell D (1992) T-cell subsets in autoimmunity. Curr opin immunol 4: 728-732.

Indexed at, Google Scholar, Crossref

5. Grace PY, Chiang D, Song SJ, Hoyte EG, Huang J, et al. (2009) Regulatory T cell dysfunction in subjects with common variable immunodeficiency complicated by autoimmune disease. Clin immunol 131: 240-253.

Indexed at, Google Scholar, Crossref

6. Kumar V, Kono DH, Urban JL, Hood L (1989) The T-cell receptor repertoire and autoimmune diseases. Annu rev immunol 7: 657-682.

Indexed at, Google Scholar, Crossref