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Vancomycin-resistant Staphylococcus aureus: a real and present danger?
1Dept. of Medical Microbiology, Royal Free and University College Medical School, London, UK. j.hamilton-miller@rfc.ucl.ac.uk
Abstract:
The glycopeptide antibiotics, vancomycin and teicoplanin, are the mainstay of therapy for infections involving strains of Staphylococcus aureus that are resistant to methicillin and gentamicin. Durng the last 5 years, clinical isolates of S. aureus showing reduced susceptibility to glycopeptides have been reported from many countries around the world, often associated with prolonged glycopeptide therapy. Detection and monitoring of such strains has been hindered by the fact that vancomycin (or glycopeptide)-intermediate S. aureus (VISA) isolates may be missed on conventional disk sensitivity tests. Effective control measures are required to prevent the increasing occurrence and spread of such strains in both the hospital and community settings. An important aspect of control is promoting the judicious use of glycopeptides. The recent introduction of the alternative antibiotics quinupristin/dalfopristin and linezolid, which are active against S. aureus strains resistant to many other classes of agent, should facilitate this process.
Insights
Reduced susceptibility to vancomycin (or glycopeptide)-intermediate Staphylococcus aureus (VISA) is a growing concern. Early detection and judicious use of antibiotics are crucial to prevent the spread of VISA strains.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Glycopeptide antibiotics (vancomycin, teicoplanin) are critical for treating methicillin-resistant Staphylococcus aureus (MRSA).
- Increasing global reports of Staphylococcus aureus with reduced glycopeptide susceptibility (VISA) are linked to prolonged therapy.
- Conventional disk sensitivity tests may fail to detect VISA, hindering monitoring.
Purpose of the Study:
- To highlight the challenge of detecting and monitoring VISA strains.
- To emphasize the need for effective control measures against VISA.
- To advocate for judicious glycopeptide use and introduce alternative antibiotics.
Main Methods:
- Review of clinical isolates and susceptibility testing data.
- Analysis of trends in VISA occurrence worldwide.
- Evaluation of diagnostic limitations for VISA detection.
Main Results:
- VISA strains are increasingly reported globally, often after extended glycopeptide treatment.
- Standard susceptibility tests can miss VISA, complicating surveillance.
- Alternative antibiotics like quinupristin/dalfopristin and linezolid offer options for resistant strains.
Conclusions:
- Effective strategies are needed to curb the rise and spread of VISA in healthcare and communities.
- Judicious use of glycopeptides is a key component of control.
- Newer antibiotics can support the judicious use of glycopeptides.