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Gram positive infection in trauma patients: new strategies to decrease emerging Gram-positive resistance and
E Ginzburg1, N Namias, M Brown
1Division of Trauma and Surgical Critical Care, Daughtry Family Department of Surgery (D-40), University of Miami School of Medicine, P.O. Box 016960, Miami, FL 33101, USA. eginzburg@miami.edu
Abstract:
Bacterial resistance to antibiotics has become a serious problem in medicine. Particularly worrisome is the increasing incidence of multi-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Not surprisingly, in view of the high incidence of life-threatening infections and heavy antibiotic use, resistance has become very frequent and problematic in intensive care units. The standard approach for the treatment of MRSA is vancomycin or teicoplanin. Long-term therapeutic and unrestricted prophylactic use of vancomycin has given rise to VRE which in turn may lead to the emergence of vancomycin-resistant S. aureus (VRSA) through plasmid mediated transmission. In order to reduce the incidence of VRE and to avoid the emergence of VRSA, vancomycin use should be restricted and alternative antibiotic strategies should be developed. Using those antibiotics to which MRSA are still generally sensitive, perhaps in combination with new ones, such as, quinupristin/dalfopristin, should be entertained. We performed a retrospective review of the Gram-positive infections in our Level 1 Trauma Center Intensive Care Unit, and an analysis of the resistance patterns of the NMSA infections showed that additional resistance rarely develops within less than 5 days. We then designed a new strategy for the treatment of MRSA infections. This strategy consists of the sequential use of a range of antibiotics with activity against MRSA in short 5-7 day pulses until the full clinical course is completed. Studies validating the benefit of this approach are currently in preparation.
Insights
Antibiotic resistance is a growing threat, especially in ICUs. A new strategy using short antibiotic pulses for methicillin-resistant Staphylococcus aureus (MRSA) infections may help combat resistance and reduce vancomycin-resistant enterococci (VRE).
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Antibiotic resistance, particularly from methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), poses a significant threat in healthcare settings.
- Intensive care units (ICUs) experience high rates of these infections due to frequent antibiotic use.
- Current MRSA treatment relies on vancomycin or teicoplanin, but overuse has led to VRE and the potential emergence of vancomycin-resistant S. aureus (VRSA).
Purpose of the Study:
- To address the rising challenge of antibiotic resistance in Gram-positive infections within an ICU setting.
- To propose and investigate an alternative antibiotic strategy for treating MRSA infections to mitigate resistance development.
- To reduce the incidence of VRE and prevent the emergence of VRSA by restricting vancomycin use.
Main Methods:
- Conducted a retrospective review of Gram-positive infections in a Level 1 Trauma Center ICU.
- Analyzed resistance patterns of MRSA infections to determine the timeframe for resistance development.
- Designed a novel treatment strategy involving sequential, short-term (5-7 day) antibiotic pulses for MRSA infections.
Main Results:
- Analysis indicated that significant additional resistance in MRSA infections rarely develops within the initial 5 days of treatment.
- The proposed strategy involves sequential antibiotic pulses to complete the full clinical course of MRSA infections.
- Studies validating this pulsed-antibiotic approach are currently underway.
Conclusions:
- Restricting vancomycin use and developing alternative strategies are crucial to combat VRE and prevent VRSA emergence.
- A sequential, pulsed antibiotic regimen for MRSA infections is a promising alternative strategy.
- Further clinical studies are needed to validate the efficacy and benefits of this novel treatment approach.