Antimicrobial approaches in the prevention ofStaphylococcus aureusinfections: a review

Abstract

BackgroundThe prophylactic application of antimicrobials that are active against Staphylococcus aureus can prevent infections. However, implementation in clinical practice is limited. We have reviewed antimicrobial approaches for the prevention of S. aureus infections.MethodsWe searched the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE and EMBASE databases and trial registries using synonyms for S. aureus, infections and prevention as search terms. We included randomized controlled trials and systematic reviews only.ResultsMost studies were conducted with mupirocin. Mupirocin is effective in preventing S. aureus infections in patients receiving dialysis treatment and in surgical patients, particularly if the patients are carriers of S. aureus. The combination of mupirocin and chlorhexidine, but not chlorhexidine alone, is also effective against S. aureus infections. So far, vaccines have not proven successful in protecting against S. aureus infections. Regarding prophylactic povidone–iodine and systemic antibiotics, there is limited evidence supporting their effectiveness against S. aureus infections. Antimicrobial honey has not been proven to be more effective or non-inferior to mupirocin in protecting against S. aureus infections.ConclusionsThe current evidence supports the use of mupirocin as prophylaxis for preventing infections with S. aureus, particularly in carriers and in the surgical setting or in patients receiving dialysis treatment. Other antimicrobial agents have not been sufficiently proven to be effective so far, or have been proven ineffective. New trials with vaccines and anti-staphylococcal peptides are currently underway and may lead to new preventive strategies in the future.

Povidone Iodine: Properties, Mechanisms of Action, and Role in Infection Control and Staphylococcus aureus Decolonization

“…This approach involves eradication of MRSA carriage from the nose through the intranasal application of an antimicrobial agent and body washes with an antiseptic soap to eliminate bacteria from other body sites ( 13 ). The most commonly used agents for MRSA decolonization are intranasal mupirocin ointment applied to the anterior nares and chlorhexidine body wash ( 13 – 15 ).…”

“…However, there are growing concerns about decolonization failures following the emergence of mupirocin ( 17 , 18 ) and chlorhexidine resistance ( 18 – 20 ). These concerns, along with suboptimal compliance and the high cost of branded nasal mupirocin ointment, have underscored the need for alternative therapies ( 15 , 21 , 22 ).…”

Short tryptophan- and arginine-rich peptide shows efficacy against clinical methicillin-resistant Staphylococcus aureus strains isolated from skin and soft tissue infections

“…MRSA is currently one of the 12 categories of bacteria listed by WHO as a priority in researching and discovering new and better therapeutic methods 24 . A few alternative therapies were proposed against MRSA during recent years, including: natural antibacterial compounds, vaccines, prophylactic antibiotics, povidone–iodine, photodynamic therapy, etc 14,25 . One of the strategies addressed is the use of Antimicrobial Peptides (AMPs), particularly the cationic peptides.…”

“…However, in a very recent report focused on the analysis of the clinical trials devoted to antimicrobial approaches against S . aureus , the antimicrobial peptides are included with only one, unsuccessful, clinical trial 14 . The main drawback of the tested AMP structures is the low therapeutic index leading to a high level of side effects in clinical trials.…”

Bioguided Purification of Active Compounds from Leaves of Anadenanthera colubrina var. cebil (Griseb.) Altschul

“…S. aureus are found in the skin, nasal cavity, and mucosal surfaces of at least one-third of the human population, these organisms can cause infections in the skin, lungs, joints, blood and central nervous system [40,41,42,43,44]. In particular, S. aureus are prevalent in the hospital environment and associated with many cases of prolonged hospitalizations and deaths [41,42,45]. Several strains of this species have also acquired resistance to multiple drugs and hypervirulent profiles; these characteristics make the treatment options for S. aureus very limited [46,47].…”