Methicillin-resistant Staphylococcus aureus (MRSA) in community and healthcare settings: A systematic review of evolving resistance mechanisms

Authors and affiliations

Kinza Panhwer^1*

1. ¹ Department of Veterinary Medicine, Faculty of Animal Husbandry & Veterinary Science, Sindh Agriculture University, Tandojam, 70060, Pakistan.

* Corresponding author: Kinza Panhwer

Methicillin-resistant Staphylococcus aureus (MRSA) is an efficient community and healthcare-associated pathogen due to its ability to transmit, colonize, be virulent, and have a high degree of genomic plasticity. This systematic narrative review compiles the latest evidence on the changing MRSA resistance mechanisms, focusing on the development of a larger adaptive phenotype of classical mecA-mediated beta-lactam resistance, appearance of mecC, GIP, transferable vancomycin resistance, daptomycin non-susceptibility, linezolid resistance, biofilm-associated tolerance, multidrug resistance through efflux, and clonal genomic adaptation. The review was conducted following PRISMA 2020 guidelines for reporting a review transparently and included landmark studies, recent reviews, public health surveillance data and authoritative guidance. The evidence suggests that rather than having one single mechanism, MRSA evolution is stimulated by multiple pressures or pressures acting together such as the effect of antibiotic exposure, the presence of biofilm associated with the use of medical devices, host immune selection, the presence of livestock and environmental reservoirs, and the spread of high-risk clones between community and healthcare settings. Community-associated lineages have established themselves in healthcare networks, while multidrug-resistance determinants have been introduced into healthcare-associated lineages, making empiric treatment more challenging. While vancomycin, daptomycin, linezolid, ceftaroline, and combination therapies continue to be clinically relevant, the importance of rapid diagnostics, source control, infection prevention, stewardship, and genomic surveillance are emerging as keys to therapeutic success. The review will conclude that high impact research on MRSA must go beyond just cataloguing resistance genes to integrated One Health surveillance, mechanism-driven diagnostics, prediction of resistance from whole genome sequencing and approaches to target tolerance, colonization and transmission as well as conventional susceptibility.

Keywords: Staphylococcus aureus methicillin-resistant; resistance; MRSA

Published:

2026-08-30

Volume and issue:

Volume 1, Issue 1

Pages:

28-37

Article ID:

IJVBS-V1I1P108

Panhwer K. Methicillin-resistant Staphylococcus aureus (MRSA) in community and healthcare settings: A systematic review of evolving resistance mechanisms. Int J Vet Biol Sci. 2026;1(1):28-37.

© 2026 the authors. Published by the International Journal of Veterinary and Biological Sciences. This article is distributed under a CC BY 4.0 licence. Read the copyright and licensing policy.