{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:51:23Z","timestamp":1792590683987,"version":"4.5.0"},"reference-count":109,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T00:00:00Z","timestamp":1732492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Infective endocarditis (IE) is a life-threatening condition with increasing global incidence, primarily caused by Staphylococcus aureus, especially methicillin-resistant strains (MRSA). Biofilm formation by S. aureus is a critical factor in pathogenesis, contributing to antimicrobial resistance and complicating the treatment of infections involving prosthetic valves and cardiovascular devices. Biofilms provide a protective matrix for MRSA, shielding it from antibiotics and host immune defenses, leading to persistent infections and increased complications, particularly in cases involving prosthetic materials. Clinical manifestations range from acute to chronic presentations, with complications such as heart failure, embolic events, and neurological deficits. Diagnosis relies on the Modified Duke Criteria, which have been updated to incorporate modern cardiovascular interventions and advanced imaging techniques, such as PET\/CT (positron emission tomography, computed tomography), to improve the detection of biofilm-associated infections. Management of MRSA-associated IE requires prolonged antimicrobial therapy, often with vancomycin or daptomycin, needing a combination of antimicrobials in the setting of prosthetic materials and frequently necessitates surgical intervention to remove infected prosthetic material or repair damaged heart valves. Anticoagulation remains controversial, with novel therapies like dabigatran showing potential benefits in reducing thrombus formation. Despite progress in treatment, biofilm-associated resistance poses ongoing challenges. Emerging therapeutic strategies, including combination antimicrobial regimens, bacteriophage therapy, antimicrobial peptides (AMPs), quorum sensing inhibitors (QSIs), hyperbaric oxygen therapy, and nanoparticle-based drug delivery systems, offer promising approaches to overcoming biofilm-related resistance and improving patient outcomes. This review provides an overview of the pathogenesis, current management guidelines, and future directions for treating biofilm-related MRSA IE.<\/jats:p>","DOI":"10.3390\/antibiotics13121132","type":"journal-article","created":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T06:25:19Z","timestamp":1732515919000},"page":"1132","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Infective Endocarditis by Biofilm-Producing Methicillin-Resistant Staphylococcus aureus\u2014Pathogenesis, Diagnosis, and Management"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2698-4151","authenticated-orcid":false,"given":"Ashlesha","family":"Kaushik","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Unity Point Health at St. Luke\u2019s Regional Medical Center and University of Iowa Carver College of Medicine, 2720 Stone Park Blvd, Sioux City, IA 51104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9207-2057","authenticated-orcid":false,"given":"Helen","family":"Kest","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases, St. Joseph\u2019s Children\u2019s Hospital, 703 Main Street, Paterson, NJ 07503, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9616-5410","authenticated-orcid":false,"given":"Mangla","family":"Sood","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Indira Gandhi Medical College, Shimla 171006, HP, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corey","family":"Thieman","sequence":"additional","affiliation":[{"name":"Division of Pharmacology, Unity Point Health at St. Luke\u2019s Regional Medical Center, 2720 Stone Park Blvd, Sioux City, IA 51104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan W.","family":"Steussy","sequence":"additional","affiliation":[{"name":"Division of Microbiology, Unity Point Health at St. Luke\u2019s Regional Medical Center, 2720 Stone Park Blvd, Sioux City, IA 51104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Padomek","sequence":"additional","affiliation":[{"name":"Division of Pharmacology, Unity Point Health at St. Luke\u2019s Regional Medical Center, 2720 Stone Park Blvd, Sioux City, IA 51104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Gupta","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care, Unity Point Health at St. Luke\u2019s Regional Medical Center, 2720 Stone Park Blvd, Sioux City, IA 51104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1161\/CIR.0000000000000296","article-title":"Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association","volume":"132","author":"Baddour","year":"2015","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3948","DOI":"10.1093\/eurheartj\/ehad193","article-title":"2023 ESC Guidelines for the management of endocarditis","volume":"44","author":"Delgado","year":"2023","journal-title":"Eur. 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