Management of acute bacterial skin and skin structure infections in India: are we equipped to meet the challenges of the growing menace of methicillin-resistant Staphylococcus aureus?

Abstract

Staphylococcus aureus (S. aureus) is a Gram-positive facultative anaerobic bacterium that colonizes the skin and nasal passages of humans. The incidence of invasive S. aureus infections has increased over the past decades and is associated with poor outcomes and high mortality rates. S. aureus is responsible for almost one-third of acute bacterial skin and skin structure infections with methicillin-resistant Staphylococcus aureus (MRSA) accounting for a large proportion of these. The S. aureus strains prevalent inIndia are more aggressive and there are recent reports of the emergence of the more virulent multidrug resistant lineages ST2371 and ST8. Management of these infections is complicated by the fact that antimicrobial stewardship is non-existent, the choice of treatment is often empirical and available treatment options are limited due to a high prevalence of resistance strains. Currently available anti-MRSA agents include vancomycin, teicoplanin, linezolid, daptomycin, tigecycline, and clindamycin. However, the emergence of resistant strains and several undesirable features related to the safety and tolerability of these agents have limited the options available for the management of MRSA infections. A newer, safe and efficacious antibiotic is thus an unmet need for the management of MRSA in patients with acute bacterial skin and skin structure infections. In this review we explore the current and future trends in the management of acute bacterial skin and skin structure infections highlighting the challenges in their management in India, and current progress in the development of some novel drugs for the management of MRSA infections.

Real-World Evidence of Efficacy and Safety of Levonadifloxacin (Oral and IV) in the Management of Acute Bacterial Skin and Skin Structure Infections (ABSSSI): Findings of a Retrospective, Multi-Center Study

“…It is also associated with minimum inhibitory concentration (MIC) creep. Teicoplanin is a bactericidal agent but requires 48 to 72 hours to achieve optimum therapeutic concentration despite administrating a loading dose, has unpredictable tissue penetration, needs dose modification in renal impaired patients, may cause nephrotoxicity, and is also associated with MIC creep [1]. Daptomycin disrupts the bacterial cell membrane, leading to rapid depolarization and cell death.…”

“…All such treatments require on-therapy monitoring of safety parameters that adds to the burden on hospital staff in terms of constant vigil for safety signals which increases the cost of treatment. However, linezolid is bacteriostatic against S. aureus but may cause peripheral neuropathy, myelosuppression, and lactic acidosis in long-term use [1]. Similarly, tigecycline is bacteriostatic and has poor tissue penetration.…”

“…Acute bacterial skin and skin structure infections (ABSSSI) are common in patients with damaged and compromised skin integrity [1]. Other predisposing factors for ABSSSI include skin conditions like tinea pedis, chronic skin lesions, and edema due to venous insufficiency [2].…”

“…Levonadifloxacin and its oral prodrug, alalevonadifloxacin, comprise a novel benzoquinolizine subclass of quinolone derivatives. These drugs have unique multispectrum antimicrobial coverage, including clinically significant Gram-positive and Gram-negative, atypical, and anaerobic pathogens [1]. Levonadifloxacin is indicated in ABSSSI, diabetic foot ulcers, and concurrent bacteremia.…”