Management of methicillin-resistant bloodstream infections: a comprehensive narrative review of available evidence focusing on current controversies and the challenges ahead.
Alberto Enrico Maraolo, Milo Gatti, Luigi Principe, Andrea Marino, Giuseppe Pipitone, Gennaro De Pascale, Giancarlo Ceccarelli
Author Information
Alberto Enrico Maraolo: Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy. ORCID
Milo Gatti: Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Luigi Principe: Microbiology and Virology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy.
Andrea Marino: Department of Clinical and Experimental Medicine, Infectious Diseases Unit, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy.
Giuseppe Pipitone: Infectious Diseases Unit, ARNAS Civico, Palermo, Italy.
Gennaro De Pascale: Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Universit�� Cattolica del Sacro Cuore, Rome, Italy.
Giancarlo Ceccarelli: Department of Public Health and Infectious Diseases, University Hospital Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
INTRODUCTION: Bloodstream infections (BSIs) caused by are common worldwide, representing one of the most relevant issues in clinical infectious diseases practice. In particular, BSIs by methicillin-resistant (MRSA-BSI) are still today a challenge since mortality burden remains elevated although decades of research. AREAS COVERED: The following topics regarding MRSA-BSI were reviewed and discussed by resorting to best available evidence retrieved from PubMed/MEDLINE up to October 2024: i) epidemiology; ii) microbiology; iii) classification, with a focus on complicated and not complicated forms; iv) the structured approach to the patient; v) pharmacokinetics and pharmacodynamics of the main antimicrobial options; vi) controversies regarding the best therapeutic approach. EXPERT OPINION: Despite ongoing efforts to better stratify and manage MRSA-BSI, there is no universally accepted classification system accurately distinguishing between uncomplicated/low risk and complicated/high risk forms. Biomarkers such as interleukin(IL)-10 hold promise in order to enable a more precise stratification, premise for an appropriate treatment plan. There is a theoretical rationale for implementing a combination therapy including a beta-lactam agent upfront, especially for patients considered at higher risk of unfavorable outcomes, but further data are necessary, and the same applies to newer adjuvants. Novel microbiological techniques may help in guiding antimicrobial duration.
