Staphylococcus aureus Skin and Soft Tissue Infections Pathogenesis and Therapeutic Approaches

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Genetic and Biochemical Studies of Antibiotic Activity and Resistance".

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 20889

Special Issue Editors

Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Maimónides, Universidad de Buenos Aires, Buenos Aires, Argentina
Interests: microbiology; immunology; infectious diseases; Staphylococcus aureus; bacterial pathogenesis
Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Maimónides, Universidad de Buenos Aires, Buenos Aires, Argentina
Interests: immunology; microbiology; infectious diseases;, Staphylococcus aureus; gene regulation
Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad de Buenos Aires, Buenos Aires, Argentina
Interests: immunology; microbiology; infectious diseases; Staphylococcus aureus; photobiology; UV radiation; skin

Special Issue Information

Dear Colleagues,

Staphylococcus aureus skin and soft tissue infections (SSTI) represent a major threat to public health given the massive number of infections and the widespread emergence of antibiotic-resistant isolates such as MRSA both in the hospital and the community. Community acquired MRSA are characterized by increased virulence and the capacity to initiate invasive staphylococcal infections even in healthy individuals. Moreover, whereas many SSTI are relatively minor and self-limiting, complicated SSTI can be life threatening. To address the increasing problems related to the actual management and treatment of SSTI, novel approaches using either preventive or alternative therapeutic strategies are urgently needed. To this end, the understanding of SSTI pathogenesis is critical to develop new strategies that can contribute not only to efficiently eradicate the bacteria from the skin but also to decrease tissue damage as well as bacterial invasion and spread to the bloodstream. The aim of this Special Issue is to provide new insights into the complex interaction of S. aureus with the host in the skin microenvironment and in novel therapeutic approaches. Therefore, we wish to invite Original Research articles and Reviews that address the following topics: 

  • SSTI pathogenesis;
  • Immune response to aureus in the skin;
  • Current antimicrobial therapies to combat SSTI;
  • Novel alternative strategies to eradicate aureus from the skin.

Dr. Marisa I. Gómez
Dr. Cintia González
Dr. Eliana Cela
Guest Editors

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Published Papers (7 papers)

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Research

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23 pages, 2589 KiB  
Article
Molecular Epidemiologic and Geo-Spatial Characterization of Staphylococcus aureus Cultured from Skin and Soft Tissue Infections from United States-Born and Immigrant Patients Living in New York City
by Lilly Cheng Immergluck, Xiting Lin, Ruijin Geng, Mike Edelson, Fatima Ali, Chaohua Li, TJ Lin, Chamanara Khalida, Nancy Piper-Jenks, Maria Pardos de la Gandara, Herminia de Lencastre, Alexander Tomasz, Teresa H. Evering, Rhonda G. Kost, Roger Vaughan and Jonathan N. Tobin
Antibiotics 2023, 12(10), 1541; https://doi.org/10.3390/antibiotics12101541 - 14 Oct 2023
Viewed by 1326
Abstract
(1) Background: With increasing international travel and mass population displacement due to war, famine, climate change, and immigration, pathogens, such as Staphylococcus aureus (S. aureus), can also spread across borders. Methicillin-resistant S. aureus (MRSA) most commonly causes skin and soft tissue [...] Read more.
(1) Background: With increasing international travel and mass population displacement due to war, famine, climate change, and immigration, pathogens, such as Staphylococcus aureus (S. aureus), can also spread across borders. Methicillin-resistant S. aureus (MRSA) most commonly causes skin and soft tissue infections (SSTIs), as well as more invasive infections. One clonal strain, S. aureus USA300, originating in the United States, has spread worldwide. We hypothesized that S. aureus USA300 would still be the leading clonal strain among US-born compared to non-US-born residents, even though risk factors for SSTIs may be similar in these two populations (2) Methods: In this study, 421 participants presenting with SSTIs were enrolled from six community health centers (CHCs) in New York City. The prevalence, risk factors, and molecular characteristics for MRSA and specifically clonal strain USA300 were examined in relation to the patients’ self-identified country of birth. (3) Results: Patients born in the US were more likely to have S. aureus SSTIs identified as MRSA USA300. While being male and sharing hygiene products with others were also significant risks for MRSA SSTI, we found exposure to animals, such as owning a pet or working at an animal facility, was specifically associated with risk for SSTIs caused by MRSA USA300. Latin American USA300 variant (LV USA300) was most common in participants born in Latin America. Spatial analysis showed that MRSA USA300 SSTI cases were more clustered together compared to other clonal types either from MRSA or methicillin-sensitive S. aureus (MSSA) SSTI cases. (4) Conclusions: Immigrants with S. aureus infections have unique risk factors and S. aureus molecular characteristics that may differ from US-born patients. Hence, it is important to identify birthplace in MRSA surveillance and monitoring. Spatial analysis may also capture additional information for surveillance that other methods do not. Full article
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13 pages, 469 KiB  
Article
The Prevalence and Molecular Biology of Staphylococcus aureus Isolated from Healthy and Diseased Equine Eyes in Egypt
by Amin Tahoun, Helmy K. Elnafarawy, Hanem El-Sharkawy, Amira M. Rizk, Mohammed Alorabi, Ahmed M. El-Shehawi, Mohamed A. Youssef, Hussam M. M. Ibrahim and Sabry El-Khodery
Antibiotics 2022, 11(2), 221; https://doi.org/10.3390/antibiotics11020221 - 10 Feb 2022
Cited by 3 | Viewed by 1652
Abstract
This work aimed to characterize S. aureus isolates from the eyes of healthy and clinically affected equines in the Kafrelsheikh Governorate, Egypt. A total of 110 animals were examined for the presence of S. aureus, which was isolated from 33 animals with [...] Read more.
This work aimed to characterize S. aureus isolates from the eyes of healthy and clinically affected equines in the Kafrelsheikh Governorate, Egypt. A total of 110 animals were examined for the presence of S. aureus, which was isolated from 33 animals with ophthalmic lesions and 77 healthy animals. We also investigated the antimicrobial resistance profile, oxacillin resistance mechanism, and the major virulence factors implicated in many studies of the ocular pathology of pathogenic S. aureus. The association between S. aureus eye infections and potential risk factors was also investigated. The frequency of S. aureus isolates from clinically affected equine eyes was significantly higher than in clinically healthy equids. A significant association was found between the frequency of S. aureus isolation from clinically affected equine eyes and risk factors including age and season but not with sex or breed factors. Antimicrobial resistance to common antibiotics used to treat equine eyes was also tested. Overall, the isolates showed the highest sensitivity to sulfamethoxazole (100%) and the highest resistance to cephalosporin (90.67%) and oxacillin (90.48%). PCR was used to demonstrate that mecA was present in 100% of oxacillin- and β-lactam-resistant S. aureus strains. The virulence factor genes Spa (x region), nuc, and hlg were identified in 62.5%, 100%, and 56%, of isolates, respectively, from clinically affected equines eyes. The severity of the eye lesions increased in the presence of γ-toxin-positive S. aureus. The phylogenetic tree of the Spa (x region) gene indicated a relationship with human reference strains isolated from Egypt as well as isolates from equines in Iran and Japan. This study provides insight into the prevalence, potential risk factors, clinical pictures, zoonotic potential, antimicrobial resistance, and β-lactam resistance mechanism of S. aureus strains that cause eye infection in equines from Egypt. Full article
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Review

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26 pages, 2946 KiB  
Review
Staphylococcus aureus Adaptation to the Skin in Health and Persistent/Recurrent Infections
by Ana-Katharina E. Gehrke, Constanza Giai and Marisa I. Gómez
Antibiotics 2023, 12(10), 1520; https://doi.org/10.3390/antibiotics12101520 - 07 Oct 2023
Viewed by 2194
Abstract
Staphylococcus aureus is a microorganism with an incredible capability to adapt to different niches within the human body. Approximately between 20 and 30% of the population is permanently but asymptomatically colonized with S. aureus in the nose, and another 30% may carry S. [...] Read more.
Staphylococcus aureus is a microorganism with an incredible capability to adapt to different niches within the human body. Approximately between 20 and 30% of the population is permanently but asymptomatically colonized with S. aureus in the nose, and another 30% may carry S. aureus intermittently. It has been established that nasal colonization is a risk factor for infection in other body sites, including mild to severe skin and soft tissue infections. The skin has distinct features that make it a hostile niche for many bacteria, therefore acting as a strong barrier against invading microorganisms. Healthy skin is desiccated; it has a low pH at the surface; the upper layer is constantly shed to remove attached bacteria; and several host antimicrobial peptides are produced. However, S. aureus is able to overcome these defenses and colonize this microenvironment. Moreover, this bacterium can very efficiently adapt to the stressors present in the skin under pathological conditions, as it occurs in patients with atopic dermatitis or suffering chronic wounds associated with diabetes. The focus of this manuscript is to revise the current knowledge concerning how S. aureus adapts to such diverse skin conditions causing persistent and recurrent infections. Full article
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26 pages, 3441 KiB  
Review
New Weapons to Fight against Staphylococcus aureus Skin Infections
by Eliana M. Cela, Dolores Urquiza, Marisa I. Gómez and Cintia D. Gonzalez
Antibiotics 2023, 12(10), 1477; https://doi.org/10.3390/antibiotics12101477 - 22 Sep 2023
Viewed by 1466
Abstract
The treatment of Staphylococcus aureus skin and soft tissue infections faces several challenges, such as the increased incidence of antibiotic-resistant strains and the fact that the antibiotics available to treat methicillin-resistant S. aureus present low bioavailability, are not easily metabolized, and cause severe [...] Read more.
The treatment of Staphylococcus aureus skin and soft tissue infections faces several challenges, such as the increased incidence of antibiotic-resistant strains and the fact that the antibiotics available to treat methicillin-resistant S. aureus present low bioavailability, are not easily metabolized, and cause severe secondary effects. Moreover, besides the susceptibility pattern of the S. aureus isolates detected in vitro, during patient treatment, the antibiotics may never encounter the bacteria because S. aureus hides within biofilms or inside eukaryotic cells. In addition, vascular compromise as well as other comorbidities of the patient may impede proper arrival to the skin when the antibiotic is given parenterally. In this manuscript, we revise some of the more promising strategies to improve antibiotic sensitivity, bioavailability, and delivery, including the combination of antibiotics with bactericidal nanomaterials, chemical inhibitors, antisense oligonucleotides, and lytic enzymes, among others. In addition, alternative non-antibiotic-based experimental therapies, including the delivery of antimicrobial peptides, bioactive glass nanoparticles or nanocrystalline cellulose, phototherapies, and hyperthermia, are also reviewed. Full article
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15 pages, 748 KiB  
Review
Staphylococcus aureus in Polymicrobial Skinand Soft Tissue Infections: Impact of Inter-Species Interactionsin Disease Outcome
by Florencia Mariani and Estela Maria Galvan
Antibiotics 2023, 12(7), 1164; https://doi.org/10.3390/antibiotics12071164 - 08 Jul 2023
Cited by 1 | Viewed by 1455
Abstract
Polymicrobial biofilms provide a complex environment where co-infecting microorganisms can behave antagonistically, additively, or synergistically to alter the disease outcome compared to monomicrobial infections. Staphylococcus aureus skin and soft tissue infections (Sa-SSTIs) are frequently reported in healthcare and community settings, and they can [...] Read more.
Polymicrobial biofilms provide a complex environment where co-infecting microorganisms can behave antagonistically, additively, or synergistically to alter the disease outcome compared to monomicrobial infections. Staphylococcus aureus skin and soft tissue infections (Sa-SSTIs) are frequently reported in healthcare and community settings, and they can also involve other bacterial and fungal microorganisms. This polymicrobial aetiology is usually found in chronic wounds, such as diabetic foot ulcers, pressure ulcers, and burn wounds, where the establishment of multi-species biofilms in chronic wounds has been extensively described. This review article explores the recent updates on the microorganisms commonly found together with S. aureus in SSTIs, such as Pseudomonas aeruginosa, Escherichia coli, Enterococcus spp., Acinetobacter baumannii, and Candida albicans, among others. The molecular mechanisms behind these polymicrobial interactions in the context of infected wounds and their impact on pathogenesis and antimicrobial susceptibility are also revised. Full article
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27 pages, 1196 KiB  
Review
Clinical Impact of Staphylococcus aureus Skin and Soft Tissue Infections
by Matthew S. Linz, Arun Mattappallil, Diana Finkel and Dane Parker
Antibiotics 2023, 12(3), 557; https://doi.org/10.3390/antibiotics12030557 - 11 Mar 2023
Cited by 16 | Viewed by 8355
Abstract
The pathogenic bacterium Staphylococcus aureus is the most common pathogen isolated in skin-and-soft-tissue infections (SSTIs) in the United States. Most S. aureus SSTIs are caused by the epidemic clone USA300 in the USA. These infections can be serious; in 2019, SSTIs with S. aureus were [...] Read more.
The pathogenic bacterium Staphylococcus aureus is the most common pathogen isolated in skin-and-soft-tissue infections (SSTIs) in the United States. Most S. aureus SSTIs are caused by the epidemic clone USA300 in the USA. These infections can be serious; in 2019, SSTIs with S. aureus were associated with an all-cause, age-standardized mortality rate of 0.5 globally. Clinical presentations of S. aureus SSTIs vary from superficial infections with local symptoms to monomicrobial necrotizing fasciitis, which can cause systemic manifestations and may lead to serious complications or death. In order to cause skin infections, S. aureus employs a host of virulence factors including cytolytic proteins, superantigenic factors, cell wall-anchored proteins, and molecules used for immune evasion. The immune response to S. aureus SSTIs involves initial responders such as keratinocytes and neutrophils, which are supported by dendritic cells and T-lymphocytes later during infection. Treatment for S. aureus SSTIs is usually oral therapy, with parenteral therapy reserved for severe presentations; it ranges from cephalosporins and penicillin agents such as oxacillin, which is generally used for methicillin-sensitive S. aureus (MSSA), to vancomycin for methicillin-resistant S. aureus (MRSA). Treatment challenges include adverse effects, risk for Clostridioides difficile infection, and potential for antibiotic resistance. Full article
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15 pages, 1958 KiB  
Review
Staphylococcus Infection: Relapsing Atopic Dermatitis and Microbial Restoration
by John Hulme
Antibiotics 2023, 12(2), 222; https://doi.org/10.3390/antibiotics12020222 - 20 Jan 2023
Cited by 4 | Viewed by 3173
Abstract
Atopic Dermatitis (AD) skin is susceptible to Staphylococcus aureus (SA) infection, potentially exposing it to a plethora of toxins and virulent determinants, including Panton-Valentine leukocidin (PVL) (α-hemolysin (Hla) and phenol-soluble modulins (PSMs)), and superantigens. Depending on the degree of infection (superficial or invasive), [...] Read more.
Atopic Dermatitis (AD) skin is susceptible to Staphylococcus aureus (SA) infection, potentially exposing it to a plethora of toxins and virulent determinants, including Panton-Valentine leukocidin (PVL) (α-hemolysin (Hla) and phenol-soluble modulins (PSMs)), and superantigens. Depending on the degree of infection (superficial or invasive), clinical treatments may encompass permanganate (aq) and bleach solutions coupled with intravenous/oral antibiotics such as amoxicillin, vancomycin, doxycycline, clindamycin, daptomycin, telavancin, linezolid, or tigecycline. However, when the skin is significantly traumatized (sheathing of epidermal sections), an SA infection can rapidly ensue, impairing the immune system, and inducing local and systemic AD presentations in susceptible areas. Furthermore, when AD presents systemically, desensitization can be long (years) and intertwined with periods of relapse. In such circumstances, the identification of triggers (stress or infection) and severity of the flare need careful monitoring (preferably in real-time) so that tailored treatments targeting the underlying pathological mechanisms (SA toxins, elevated immunoglobulins, impaired healing) can be modified, permitting rapid resolution of symptoms. Full article
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