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JAC Advance Access originally published online on December 5, 2007
Journal of Antimicrobial Chemotherapy 2008 61(2):246-253; doi:10.1093/jac/dkm465
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Review

The effect of antibiotics on methicillin-resistant Staphylococcus aureus

S. J. Dancer*

Department of Microbiology, Southern General Hospital, Glasgow G51 4TF, Scotland, UK

* Tel: +44-141-201-1705; Fax: +44-141-201-1704; E-mail: stephanie.dancer{at}sgh.scot.nhs.uk

Antimicrobial drugs encourage the overgrowth of organisms resistant to the agents used. Acquisition and subsequent overgrowth of methicillin-resistant Staphylococcus aureus (MRSA) are particularly associated with β-lactam antibiotics and quinolones. These drugs allow rapid proliferation of an organism that might have been merely colonizing the skin, leading to clinical infection, treatment difficulties and potential transmission to others. In addition, there is increasing evidence that inappropriate antibiotics not only encourage overgrowth with MRSA but may also enhance pathogenicity. Such virulence is not necessarily due to simple expansion of MRSA across skin and mucosal surfaces; there appear to be molecular changes that facilitate mechanisms such as quorum sensing, adhesion, phage mobilization, exotoxin production, intracellular persistence and biofilm formation, all of which contribute towards more severe infection. This review examines the association between MRSA and certain classes of antibiotics and explores the molecular mechanisms underlying a perceived increase in virulence following inappropriate therapy. It is possible that empirical prescribing has a significant impact on the management of MRSA infections and ultimately patient outcome. It is time to challenge the prescribers’ right to prescribe what they like, when they like, for patients at risk of MRSA.

Keywords: MRSA , antimicrobial chemotherapy , virulence


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