Letter to the Editor: Global prevalence and antimicrobial resistance of Staphylococcus aureus in musculoskeletal infections: insights and future directions

HIGHLIGHTS Regional differences in S. aureus prevalence and AMR should be interpreted in light of local healthcare infrastructure, diagnostic capacity, and comorbidity profiles rather than directly extrapolated between settings. Early and systematic surveillance of vancomycin resistance and multidrug-resistant S. aureus is needed to safeguard existing treatment options and to guide the evaluation of novel therapies. Coordinated, longitudinal surveillance in underrepresented and resource-limited regions is crucial to close current evidence gaps and to guide context-appropriate prevention and treatment strategies for musculoskeletal infections. Dear Editor, We congratulate Wang et al on their comprehensive systematic review and meta-analysis of the global prevalence and antimicrobial resistance (AMR) of Staphylococcus aureus in musculoskeletal infections[1]. This study offers crucial insights into the widespread burden of S. aureus and the growing challenges posed by antibiotic resistance. The pooled incidence of S. aureus infection (33%) and the marked global variation in prevalence provide a critical foundation for future research and clinical strategies in managing musculoskeletal infections. In this letter, we aim to complement these findings by proposing potential explanations for the observed regional heterogeneity in S. aureus infection and by emphasizing the clinical implications of emerging resistance patterns, thereby clarifying key learning points for clinicians and researchers. First, the lower prevalence of S. aureus in Asia compared with Europe and North America warrants further exploration. This pattern may reflect differences in healthcare practices, diagnostic capacity, or circulating pathogen strains across regions. We encourage the authors and future investigators to assess underlying factors such as healthcare infrastructure, access to microbiological diagnostics, and the burden of chronic conditions such as diabetes, which may contribute to these regional differences. Furthermore, more detailed reporting of regional variations in AMR, particularly in underrepresented regions like Oceania and Africa, would provide a more complete and context-specific picture of global AMR trends. Second, although the study carefully describes the antibiotic resistance profile of S. aureus, a deeper focus on the emerging issue of vancomycin resistance may further strengthen the clinical message. Despite its low incidence (1%), it poses a substantial threat to current treatment options[2]. Exploring the mechanisms of vancomycin resistance, monitoring temporal trends in vancomycin minimum inhibitory concentrations, and linking these data with clinical outcomes could further enrich the discussion of AMR in musculoskeletal infections. Given the alarming rise in multidrug-resistant strains, it would also be useful to discuss alternative or adjunctive treatment strategies, such as bacteriophage therapy and other novel anti-infective approaches, which are gaining attention as promising options for resistant infections[3]. Third, the study’s findings highlight the importance of standardized global surveillance of S. aureus infections and AMR. As noted by the authors, addressing epidemiological gaps in underrepresented regions is essential. We suggest that future research focus on longitudinal surveillance studies tracking the prevalence and resistance patterns of S. aureus over time, particularly in low-resource settings, to assess the impact of new preventive and therapeutic strategies. Harmonized definitions, diagnostic protocols, and reporting frameworks would help to reduce heterogeneity, improve comparability across studies, and ensure that data from diverse geographical areas can inform global policy and practice. Taken together, the work by Wang et al and the perspectives outlined above yield several practical learning points: (1) regional differences in S. aureus prevalence and AMR should be interpreted in light of local healthcare infrastructure, diagnostic capacity, and comorbidity profiles rather than directly extrapolated between settings; (2) early and systematic surveillance of vancomycin resistance and multidrug-resistant S. aureus is needed to safeguard existing treatment options and to guide the evaluation of novel therapies; and (3) coordinated, longitudinal surveillance in underrepresented and resource-limited regions is crucial to close current evidence gaps and to guide context-appropriate prevention and treatment strategies for musculoskeletal infections. We commend the authors for their valuable contribution and believe that incorporating these considerations will further enhance the clinical and public health impact of their work on global strategies for managing S. aureus musculoskeletal infections. Authors acknowledge the use of OpenAI’s language model for grammar and language refinement during the writing process. The work has been reported in line with the TITAN criteria[4].