Healthy Skepticism Library item: 1049

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Publication type: news

Gottlieb S.
CDC reports first case of vancomycin resistant Staphylococcus aureus
BMJ 2003 Apr 12
http://www.bmj.com/cgi/content/extract/326/7393/783/a

Full text:

The Centers for Disease Control and Prevention (CDC) has reported
that in summer 2002, a 40 year old Michigan woman became the first
person worldwide known to have been infected with a strain of
Staphylococcus aureus that was resistant to the antibacterial
vancomycin
The Michigan woman developed foot ulcers and other skin infections
after becoming infected with the bacterium following an amputation.
She recovered after doctors prescribed a different course of
antibiotics. The CDC said the case highlighted the growing problem of
antibiotic resistance (New England Journal of Medicine
2003;348:1342-7).
Until recently, vancomycin was the only uniformly effective treatment
for staphylococcal infections. In 1997, the first clinical isolate of S
aureus with reduced susceptibility to vancomycin was reported, and
since June 2002, eight confirmed infections with such strains have
been reported in patients in the United States. The minimal inhibitory
concentrations of vancomycin (the amount of the antibiotic needed to
keep the bacteria from replicating) reported for these isolates are in
the intermediate range (8-16 micrograms/ml) according to criteria
defined by the National Committee for Clinical Laboratory Standards.
Staphylococcal isolates with reduced susceptibility to glycopeptides,
such as vancomycin and teicoplanin, are a serious public health
problem because staphylococci frequently show multidrug resistance,
and glycopeptides are the only remaining effective drugs. The CDC
also confirmed that a second, unrelated vancomycin resistant
staphylococcal infection had been confirmed in Pennsylvania several
months after the Michigan case.
“Although the infection in the patient in this first case was treatable
with other antibiotics, these findings remind us of the need for
infection control and judicious use of antibiotics in the healthcare
setting to prevent antibiotic resistance,” said Dr Julie Gerberding,
director of the CDC.
Nearly all strains of S aureus in the United States are now resistant to
penicillin. Doctors embraced vancomycin in the late 1990s as
resistant forms of the bacterium spread from hospital settings into the
community.