Community-acquired methicillin-resistant Staphylococcus aureus: is it still a significant pathogen for skin and soft tissue infections? A 30-year overview

Abstract

Este artículo revisa la evolución epidemiológica, clínica y microbiológica de las infecciones cutáneas y de partes blandas causadas por Staphylococcus aureus resistente a meticilina adquirido en la comunidad (CA-MRSA) durante los últimos 30 años. Tras un marcado aumento de la incidencia en la década de 2000, especialmente en Estados Unidos con la expansión del clon USA300, en los últimos años se observa un descenso sostenido en países desarrollados de Europa, Norteamérica y Australia. Sin embargo, la carga de enfermedad sigue siendo elevada y heterogénea en regiones de América Latina, Asia y África, donde circulan clones con alto potencial epidémico. El artículo describe la distribución geográfica de los principales linajes, los factores de riesgo, las manifestaciones clínicas, los mecanismos de transmisión, las características microbiológicas y las opciones terapéuticas actuales. Los autores concluyen que, aunque la prevalencia ha disminuido en muchos países, la globalización, la migración y los viajes internacionales mantienen el riesgo de reemergencia, lo que hace imprescindible una vigilancia epidemiológica continua y estrategias de control adaptadas a cada región. Purpose of reviewPurpose of review: The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in skin and soft tissue infections (SSTI) has significantly changed in recent decades. We conducted a literature review to determine whether this microorganism, which became increasingly common as a cause of SSTI in the 2000s, still plays a significant role in these infections today.

Recent findings: Over the past 30 years, there has been a pattern of increase and then decrease in these infections. The highest frequency was observed in the United States, to the extent that guidelines recommended empirical antibiotic treatment for this pathogen in SSTI. Clone USA300 is the primary causative agent in the United States. In Europe, SSTI are much less common than in the United States, and the presence of this clone has been significantly lower. A decrease in the frequency of SSTI and CA-MRSA has been observed in developed countries. However, the spread of specific clones in Latin America, Asia and Africa highlights the need for rigorous global surveillance.

Summary: In recent years, the prevalence of CA-MRSA SSTI has decreased in developed countries. However, globalisation, immigration and intercontinental travel have favoured the spread of some clones with epidemic potential. It remains to be seen whether the current lower frequency will be maintained or whether these clones will give rise to a new wave.