Advances in <i>Staphylococcus aureus</i> extracellular vesicles: navigating challenges, embracing prospects

Staphylococcus aureus has emerged as a globally widespread pathogen, and its growing antibiotic resistance poses severe challenges to human health. With the advancing research on bacterial extracellular vesicles (bEVs), S. aureus EVs, have been found to act as pathogenic factors, exacerbating the pathophysiology of S. aureus infections. This review summarizes current research on S. aureus EVs, outlining their roles in promoting virulence and contributing to antibiotic resistance, which provides insights into the pathogenic mechanisms and the emergence of resistance in S. aureus. We also summarize certain natural compounds that exhibit disruptive effects on S. aureus EVs, which may offer new strategies for treating S. aureus infections. Although S. aureus EVs aggravate disease progression, their unique properties can be harnessed through bioengineering techniques. This review further highlights the potential applications of S. aureus EVs in vaccine development, drug delivery, and innovative anti-tumor or antiviral therapies. However, the rapid emergence of new technologies and the discovery of non-vesicular nanoparticles have cast doubt on previously established findings. Therefore, this review also addresses the following questions: How should we interpret these existing discoveries? And how should we advance future research related to S. aureus EVs?