The role of Staphylococcus aureus colonization and decolonization strategies in preventing pulmonary infections

Staphylococcus aureus (S. aureus) colonization in humans is a significant risk factor for invasive pulmonary infections and a leading cause of infectious disease mortality globally. Since S. aureus infections commonly arise from asymptomatic colonization, decolonization is recognized as a crucial strategy for prevention. Current decolonization strategies primarily involve antibiotic-based and antiseptic-based eradication of S. aureus. Despite their clinical efficacy, S. aureus infection rates persist with rising resistance to decolonizing agents. This review summarizes the characteristics of S. aureus colonization, elucidates the mechanisms linking colonization to pulmonary infection, and describes current prevention and control strategies, including active surveillance, universal decolonization, and targeted decolonization. We also discuss current challenges in the context of colonialism, along with emerging approaches, such as retapamulin, antimicrobial peptides, and probiotic-based strategies, to support the clinical prevention and treatment of S. aureus-associated pulmonary infections.