Infective Endocarditis by Biofilm-Producing Methicillin-Resistant <i>Staphylococcus aureus</i>—Pathogenesis, Diagnosis, and Management
Infective endocarditis (IE) is a life-threatening condition with increasing global incidence, primarily caused by <i>Staphylococcus aureus</i>, especially methicillin-resistant strains (MRSA). Biofilm formation by <i>S. aureus</i> is a critical factor in pathogenesis, contrib...
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MDPI AG
2024-11-01
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| author | Ashlesha Kaushik Helen Kest Mangla Sood Corey Thieman Bryan W. Steussy Michael Padomek Sandeep Gupta |
| author_facet | Ashlesha Kaushik Helen Kest Mangla Sood Corey Thieman Bryan W. Steussy Michael Padomek Sandeep Gupta |
| author_sort | Ashlesha Kaushik |
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| description | Infective endocarditis (IE) is a life-threatening condition with increasing global incidence, primarily caused by <i>Staphylococcus aureus</i>, especially methicillin-resistant strains (MRSA). Biofilm formation by <i>S. aureus</i> is a critical factor in pathogenesis, contributing to antimicrobial resistance and complicating the treatment of infections involving prosthetic valves and cardiovascular devices. Biofilms provide a protective matrix for MRSA, shielding it from antibiotics and host immune defenses, leading to persistent infections and increased complications, particularly in cases involving prosthetic materials. Clinical manifestations range from acute to chronic presentations, with complications such as heart failure, embolic events, and neurological deficits. Diagnosis relies on the Modified Duke Criteria, which have been updated to incorporate modern cardiovascular interventions and advanced imaging techniques, such as PET/CT (positron emission tomography, computed tomography), to improve the detection of biofilm-associated infections. Management of MRSA-associated IE requires prolonged antimicrobial therapy, often with vancomycin or daptomycin, needing a combination of antimicrobials in the setting of prosthetic materials and frequently necessitates surgical intervention to remove infected prosthetic material or repair damaged heart valves. Anticoagulation remains controversial, with novel therapies like dabigatran showing potential benefits in reducing thrombus formation. Despite progress in treatment, biofilm-associated resistance poses ongoing challenges. Emerging therapeutic strategies, including combination antimicrobial regimens, bacteriophage therapy, antimicrobial peptides (AMPs), quorum sensing inhibitors (QSIs), hyperbaric oxygen therapy, and nanoparticle-based drug delivery systems, offer promising approaches to overcoming biofilm-related resistance and improving patient outcomes. This review provides an overview of the pathogenesis, current management guidelines, and future directions for treating biofilm-related MRSA IE. |
| format | Article |
| id | doaj-art-35cd26f50fe64ff8a101d96eead968c7 |
| institution | DOAJ |
| issn | 2079-6382 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj-art-35cd26f50fe64ff8a101d96eead968c72025-08-20T02:53:18ZengMDPI AGAntibiotics2079-63822024-11-011312113210.3390/antibiotics13121132Infective Endocarditis by Biofilm-Producing Methicillin-Resistant <i>Staphylococcus aureus</i>—Pathogenesis, Diagnosis, and ManagementAshlesha Kaushik0Helen Kest1Mangla Sood2Corey Thieman3Bryan W. Steussy4Michael Padomek5Sandeep Gupta6Division of Pediatric Infectious Diseases, Unity Point Health at St. Luke’s Regional Medical Center and University of Iowa Carver College of Medicine, 2720 Stone Park Blvd, Sioux City, IA 51104, USADivision of Pediatric Infectious Diseases, St. Joseph’s Children’s Hospital, 703 Main Street, Paterson, NJ 07503, USADepartment of Pediatrics, Indira Gandhi Medical College, Shimla 171006, HP, IndiaDivision of Pharmacology, Unity Point Health at St. Luke’s Regional Medical Center, 2720 Stone Park Blvd, Sioux City, IA 51104, USADivision of Microbiology, Unity Point Health at St. Luke’s Regional Medical Center, 2720 Stone Park Blvd, Sioux City, IA 51104, USADivision of Pharmacology, Unity Point Health at St. Luke’s Regional Medical Center, 2720 Stone Park Blvd, Sioux City, IA 51104, USADivision of Pulmonary and Critical Care, Unity Point Health at St. Luke’s Regional Medical Center, 2720 Stone Park Blvd, Sioux City, IA 51104, USAInfective endocarditis (IE) is a life-threatening condition with increasing global incidence, primarily caused by <i>Staphylococcus aureus</i>, especially methicillin-resistant strains (MRSA). Biofilm formation by <i>S. aureus</i> is a critical factor in pathogenesis, contributing to antimicrobial resistance and complicating the treatment of infections involving prosthetic valves and cardiovascular devices. Biofilms provide a protective matrix for MRSA, shielding it from antibiotics and host immune defenses, leading to persistent infections and increased complications, particularly in cases involving prosthetic materials. Clinical manifestations range from acute to chronic presentations, with complications such as heart failure, embolic events, and neurological deficits. Diagnosis relies on the Modified Duke Criteria, which have been updated to incorporate modern cardiovascular interventions and advanced imaging techniques, such as PET/CT (positron emission tomography, computed tomography), to improve the detection of biofilm-associated infections. Management of MRSA-associated IE requires prolonged antimicrobial therapy, often with vancomycin or daptomycin, needing a combination of antimicrobials in the setting of prosthetic materials and frequently necessitates surgical intervention to remove infected prosthetic material or repair damaged heart valves. Anticoagulation remains controversial, with novel therapies like dabigatran showing potential benefits in reducing thrombus formation. Despite progress in treatment, biofilm-associated resistance poses ongoing challenges. Emerging therapeutic strategies, including combination antimicrobial regimens, bacteriophage therapy, antimicrobial peptides (AMPs), quorum sensing inhibitors (QSIs), hyperbaric oxygen therapy, and nanoparticle-based drug delivery systems, offer promising approaches to overcoming biofilm-related resistance and improving patient outcomes. This review provides an overview of the pathogenesis, current management guidelines, and future directions for treating biofilm-related MRSA IE.https://www.mdpi.com/2079-6382/13/12/1132methicillin-resistant <i>Staphylococcus aureus</i>MRSAbiofilminfective endocarditisantibioticstreatment |
| spellingShingle | Ashlesha Kaushik Helen Kest Mangla Sood Corey Thieman Bryan W. Steussy Michael Padomek Sandeep Gupta Infective Endocarditis by Biofilm-Producing Methicillin-Resistant <i>Staphylococcus aureus</i>—Pathogenesis, Diagnosis, and Management Antibiotics methicillin-resistant <i>Staphylococcus aureus</i> MRSA biofilm infective endocarditis antibiotics treatment |
| title | Infective Endocarditis by Biofilm-Producing Methicillin-Resistant <i>Staphylococcus aureus</i>—Pathogenesis, Diagnosis, and Management |
| title_full | Infective Endocarditis by Biofilm-Producing Methicillin-Resistant <i>Staphylococcus aureus</i>—Pathogenesis, Diagnosis, and Management |
| title_fullStr | Infective Endocarditis by Biofilm-Producing Methicillin-Resistant <i>Staphylococcus aureus</i>—Pathogenesis, Diagnosis, and Management |
| title_full_unstemmed | Infective Endocarditis by Biofilm-Producing Methicillin-Resistant <i>Staphylococcus aureus</i>—Pathogenesis, Diagnosis, and Management |
| title_short | Infective Endocarditis by Biofilm-Producing Methicillin-Resistant <i>Staphylococcus aureus</i>—Pathogenesis, Diagnosis, and Management |
| title_sort | infective endocarditis by biofilm producing methicillin resistant i staphylococcus aureus i pathogenesis diagnosis and management |
| topic | methicillin-resistant <i>Staphylococcus aureus</i> MRSA biofilm infective endocarditis antibiotics treatment |
| url | https://www.mdpi.com/2079-6382/13/12/1132 |
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