Molecular Epidemiology Clinical Manifestations, Decolonization Strategies, and Treatment Options of Methicillin-Resistant <em>Staphylococcus aureus </em>Infection in Neonates

Neonatal methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection remain a major concern in the neonatal intensive care unit (NICU). MRSA is associated with significant neonatal morbidity and mortality globally, whereas prematurity and low birth weight are the main risk factors. We aimed to review the existing evidence regarding the molecular characteristics, epidemiology, risk factors, clinical manifestations, decolonization strategies, and treatment options of MRSA infection in neonates. Healthcare-associated (HA)-MRSA and community-acquired (CA)-MRSA strains differ in their synthesis of toxins, including Panton-Valentine leukocidin, molecular characteristics, and resistance to antibiotics. Colonization with MRSA is the main risk factor, associated with high risk of infection. The clinical impact of MRSA infection includes bacteremia, sepsis, endocarditis, pneumonia, osteomyelitis, septic arthritis, skin and soft tissue infections, and toxic shock syndrome. To lower MRSA colonization, infection, and transmission, customized approaches are required, including continuous local surveillance of MRSA clinical and molecular epidemiology, new techniques for MRSA identification, and the application of basic preventive measures. To identify the best empirical antimicrobial treatments, antibiotic susceptibility monitoring is essential. The growing antibiotic resistance of MRSA remains challenging, while vancomycin is still the best option. Further extensive research and surveillance are warranted to explore the genetic variety and prevalence of MRSA.