# Methicillin-Resistant Staphylococcus aureus in Urinary Tract Infections: A Comprehensive Review With Insights From a North Indian Cohort

## TL;DR

This paper reviews the global and North Indian trends of MRSA causing urinary tract infections, highlighting their risks, resistance patterns, and the need for improved diagnostics and stewardship.

## Contribution

The study provides a comprehensive review of MRSA UTIs, emphasizing insights from a North Indian cohort and global trends in antimicrobial resistance and diagnostics.

## Key findings

- MRSA UTI prevalence ranges from 2% to over 10%, influenced by geography and patient factors.
- Vancomycin and linezolid remain effective against MRSA, while resistance to β-lactams and fluoroquinolones is widespread.
- Molecular diagnostics like PCR improve detection accuracy and support antimicrobial stewardship.

## Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) remains a major global public health concern, with urinary tract infections (UTIs) representing a less common but clinically important manifestation. Although Gram-negative bacteria remain the predominant uropathogens, increasing MRSA detection in urinary isolates presents diagnostic and therapeutic challenges, particularly in high-risk groups such as catheterised or hospitalised patients. This review consolidates global evidence published between 2000 and 2025, focusing on the epidemiology, molecular characteristics, antimicrobial resistance, diagnostics, and management of MRSA UTIs. Reported prevalence ranges from 2% to over 10%, varying with geography and patient factors. Key virulence mechanisms include urine-induced gene expression, copper resistance, metabolic adaptability, and biofilm formation, which enhance persistence and treatment failure risk. Resistance to β-lactams, fluoroquinolones, and aminoglycosides is widespread, whereas vancomycin and linezolid remain reliably effective. Advances in molecular diagnostics, such as PCR and sequencing, have improved detection accuracy and supported antimicrobial stewardship. MRSA, though relatively uncommon, poses significant risks to vulnerable populations and exemplifies broader global antimicrobial resistance trends. Strengthened surveillance, rapid diagnostics, judicious empiric therapy, and stewardship programs, integrated within a One Health framework, are essential to reduce the growing burden of MRSA urinary infections worldwide.