Introduction
Methicillin-resistant Staphylococcus aureus (MRSA) remains a major global public health concern, particularly due to its ability to cause severe and life-threatening infections in immunocompromised individuals. The differentiation of MRSA into healthcare-associated MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA) is clinically significant, as these categories differ in epidemiology, risk factors, virulence, and treatment strategies. Nasal colonization plays a key role in MRSA transmission, making surveillance essential. Mupirocin is widely used for nasal decolonization; however, the emergence of mupirocin resistance threatens its effectiveness. Additionally, biofilm formation enhances bacterial persistence and resistance, especially in healthcare settings, underscoring the importance of understanding its role in MRSA-related infections.
Epidemiology and Prevalence of MRSA
The prevalence of MRSA in the studied population was relatively low, with only 3.37% of nasal swab samples testing positive. Despite this low overall prevalence, HA-MRSA accounted for the majority of cases, indicating that hospitals remain a critical reservoir for MRSA transmission. The dominance of HA-MRSA highlights the continued burden of healthcare-associated infections (HCAIs) and reflects the selective pressure exerted by prolonged hospitalization, antimicrobial exposure, and invasive medical interventions. Continuous epidemiological surveillance is therefore essential to monitor trends and guide infection control strategies.
Risk Factors Associated with HA-MRSA and CA-MRSA
Distinct risk factor profiles were observed for HA-MRSA and CA-MRSA, reinforcing the importance of targeted preventive measures. HA-MRSA was predominantly associated with older age, prolonged hospital stay, ICU admission, indwelling medical devices, invasive procedures, prior antimicrobial therapy, and previous MRSA carriage. In contrast, CA-MRSA was more common among younger individuals and linked to crowded living conditions, sharing of personal items, skin injuries, and tattooing practices. Understanding these risk factors enables clinicians and public health professionals to implement tailored interventions for different populations.
Mupirocin Resistance among MRSA Strains
Mupirocin resistance was detected at a very low prevalence, suggesting that mupirocin remains largely effective for MRSA decolonization in the current setting. Nevertheless, even minimal resistance is clinically relevant, as it can compromise decolonization efforts and facilitate persistent colonization and transmission. Regular monitoring of mupirocin susceptibility is therefore crucial to ensure the continued success of nasal decolonization programs and to prevent the silent spread of resistant strains within healthcare facilities.
Biofilm Production and Its Clinical Significance
Biofilm formation was observed in all HA-MRSA isolates, while only a small proportion of CA-MRSA strains demonstrated this ability. Biofilms provide a protective environment that enhances bacterial survival, promotes antimicrobial resistance, and facilitates chronic infection, particularly in association with medical devices. The strong association between biofilm production and HA-MRSA suggests a direct link between biofilm-mediated virulence and healthcare-associated infections, emphasizing the need for strategies that target biofilm prevention and disruption.
Implications for Infection Prevention and Control
Although the prevalence of MRSA and mupirocin resistance is low, the predominance of biofilm-producing HA-MRSA strains represents a significant challenge for healthcare systems. Strict adherence to Infection Prevention and Control (IPC) measures, including hand hygiene, contact precautions, antimicrobial stewardship, and routine surveillance, is essential to limit MRSA transmission. Addressing biofilm-associated virulence and maintaining the effectiveness of decolonization agents like mupirocin are key priorities for reducing the burden of MRSA-related healthcare-associated infections.
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