Methicillin resistant staphylococcus aureus treatment and control in neonates: lessons learned - a Vietnam perspective.

INTRODUCTION: Vietnam bears a substantial burden of methicillin-resistant Staphylococcus aureus (MRSA), yet neonatal data on epidemiology, antimicrobial resistance, treatment, and prevention remain limited and fragmented across regions and healthcare settings. AREAS COVERED: This review summarizes MRSA epidemiology, risk factors, treatment, and prevention in neonatal intensive care units (NICUs), identifies key knowledge gaps, and highlights priorities for clinical practice, antimicrobial stewardship, and future research to support more effective management and control strategies. MRSA comprises 73% of S. AUREUS: isolates nationally, with notable regional variation. Antibiotic overuse is common, affecting roughly 67.4% of hospitalized patients, and up to 90% of pediatric prescriptions are inappropriate, driving resistance. Vancomycin remains the first-line therapy for severe MRSA infections. Alternative agents - including linezolid, daptomycin, ceftaroline, clindamycin, and adjunctive rifampin - have limited roles, underscoring the importance of local antibiogram-guided therapy. EXPERT OPINION: Optimizing vancomycin use through AUC-guided dosing, therapeutic drug monitoring, and de-escalation is critical to balance efficacy and toxicity. Although MRSA remains largely susceptible to vancomycin, the emergence of vancomycin-resistant enterococci (up to 34%) threatens last-line treatment sustainability. Effective strategies to reduce MRSA burden include infection prevention bundles, surveillance cultures, targeted decolonization, and antimicrobial stewardship programs. These interventions must be tailored to Vietnam's healthcare.