CDC Investigates First Case Of VRSA

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By Brian McCurdy, Associate Editor

Researchers at the Centers for Disease Control and Prevention (CDC) recently discovered the first reported case of vancomycin-resistant Staphylococcus aureus (VRSA) in the world. The organism was identified in a patient in Michigan, had not spread to anyone else and is susceptible to other antibiotics, according to the CDC Web site.
The 40-year-old woman was treated on an outpatient basis, has complicated diabetes and peripheral vascular disease, and undergoes hemodialysis on a regular basis, according to Dr. David Johnson, Deputy Director and Chief Medical Executive of the Michigan Department of Community Health. The VRSA is susceptible to trimethoprim-sulfamethoxazole and linezolid (ph), notes Dr. Steve Solomon, the CDC’s Acting Director of the Division of Health Care Quality Promotion, in a CDC release.

Guy Pupp, DPM, Director of the Diabetic Foot Clinic at Kern Hospital and Medical Center in Warren, Mich., treated the woman after the CDC contacted him. He says she is doing well and doctors are close to getting the last of three negative cultures for her VRSA.
“This is a big deal. Our fears (over increasing resistant strains) have been realized,” says Dr. Pupp, who is also the Clinic Director at the Sinai Grace Diabetic Foot Center in Detroit. However, he notes that identifying the resistant strain has also been “a big victory.”
Dr. Pupp treated the woman on an outpatient basis and says the CDC cordoned off areas in the Michigan hospital, had medical personnel wear special suits with hoods and took other precautions so the woman’s infection would not spread. He says the CDC was “efficient” to work with and took 500 cultures during its investigation of everyone who had contact with the patient. Dr. Pupp says his aggressive debridement was successful.

Was It The Result Of Rising Nosocomial Infections?
Adam Landsman, DPM, PhD, says the increase in Staph infections and shift from gram negative to gram positive bacteria over the past few years is a fact that can’t be ignored.
“The emergence of Staph resistance to vancomycin is of great concern because it symbolizes the fact that bacteria are going to do what we expect them to do ... become resistant to even the strongest antibiotics,” says Dr. Landsman, Director of Research and Adjunct Professor of Biologic Sciences at Dr. William A. Scholl College of Podiatric Medicine at Finch University.
Dr. Landsman attributes the discovery to the prevalence of nosocomial infections, noting the CDC recently released a series of guidelines that should be followed to help reduce these infections. The CDC feels the discovery of the Staph poses an insignificant risk to the general public. “This case does serve to reinforce for those of us in health care the absolute necessity of adhering to strict infection control precautions, as has been done in this case, and to continue to use antibiotics wisely and judiciously,” notes Dr. Solomon.
As Dr. Landsman suggests, one way of combating these infections is reducing the frequency of hospital admissions when outpatient management is possible. He says podiatrists often admit patients with serious infections for surgical treatment (i.e., incision and drainage), followed by a course of intravenous antibiotics for seven to 10 days in the hospital. This “gives patients great exposure to resistant bacteria and may cause colonization or full infection,” explains Dr. Landsman.
As a result, he is trying to minimize hospital and IV exposure when possible by using strong oral medications, such as linezolid (Zyvox, Pharmacia), to treat his diabetic patients who have serious infections. Linezolid has tissue penetration equal to IV medications without the IV-associated side effects, according to Dr. Landsman. He emphasizes that linezolid is indicated for both methicillin-resistant Staph aureus and vancomycin-resistant Staph.

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