scholarly journals Treating Central Catheter–Associated Bacteremia Due to Methicillin-Resistant Staphylococcus aureus: Beyond Vancomycin

2016 ◽  
Vol 36 (4) ◽  
pp. 46-57
Author(s):  
Shannon Holt ◽  
Kelly A. Thompson-Brazill ◽  
E. Ryan Sparks ◽  
Juliana Lipetzky

Methicillin-resistant Staphylococcus aureus is a frequent cause of hospital-associated infections, including central catheter–associated bacteremia. Vancomycin has been the drug of choice for treating this type of bacteremia for decades in patients who have no contraindications to the antibiotic. However, resistance to vancomycin is an emerging problem. Newer antibiotics approved by the Food and Drug Administration have activity against methicillin-resistant S aureus. Some of the antibiotics also have activity against strains of S aureus that are intermediately susceptible or resistant to vancomycin. This article uses a case study to highlight the clinical signs of vancomycin failure and describes the indications for and appropriate use of alternative antimicrobials such as ceftaroline, daptomycin, linezolid, tigecycline, and telavancin. (Critical Care Nurse. 2016;36[4]:46–57)

2014 ◽  
Vol 4 (7) ◽  
pp. 548-551 ◽  
Author(s):  
CP Bhatt ◽  
BMS Karki ◽  
B Baral ◽  
S Gautam ◽  
A Shah ◽  
...  

Background: Methicillin resistant Staphylococcus aureushas emerged as one of the most important nosocomial pathogens. It invokes a tremendous financial burden and enhanced morbidity and mortality due to difficult to treat systemic infections.Aim of this study was to determine antibiotic susceptibility pattern of Staphylococcus aureus and Methicillin resistant Staphylococcus aureus. Materials and Methods: Different clinical specimens were collected and processed for routine culture and antibiotic sensitivity test by standard microbiology techniques. Results: Out of 1173 samples received for microbiological examination, 100 were found to be S. aureus with 19% cases were Methicillin resistant Staphylococcus aureus (MRSA). Fourteen MRSA were found from inpatient and 5 were from outpatient. MRSA was found higher in female than male and maximum number (31.5%) was found in age group 0-10 years. Staphylococcus aureus was 100% sensitive to Vancomycin followed by Amikacin (90%), Gentamycin (83%), and tetracycline (81%). On urine isolates Nitrofurantoin(91.6%) was drug of choice. All the isolates were resistant to Penicillin G. In case of Methicillin resistant Staphylococcus aureus showed 100% sensitive to Vancomycin followed by Amikacin (84.2%), Tetracycline (63.1%), Ciprofloxacin (42%) and Gentamycin (36.8%). Among urine isolates Nitrofutantoin showed 87.5% sensitive followed by Norfloxacin (75%). Conclusion: Methicillin resistant Staphylococcus aureus was found 19% of Staphylococcus aureus isolates. It was most common in females, hospitalized patients and young age group. Vancomycin seems to be drug of choice followed by Amikacin. It would be helpful to formulating and monitoring the antibiotic policy and ensure proper empiric treatment. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10297 Journal of Pathology of Nepal (2014) Vol. 4, 548-551   


2018 ◽  
Vol 10 (02) ◽  
pp. 145-148 ◽  
Author(s):  
Afzal Husain ◽  
Vinita Rawat ◽  
Mukesh Kumar ◽  
Pankaj Kumar Verma ◽  

ABSTRACT INTRODUCTION: The efficacy of vancomycin, drug of choice for methicillin-resistant Staphylococcus aureus (MRSA), has become questionable due to the emergence of MRSA isolates with reduced susceptibility. The present study was conducted to determine the vancomycin, linezolid, and daptomycin susceptibility pattern in clinical isolates of MRSA and to observe minimum inhibitory concentration (MIC) creep over 2 years if any. MATERIALS AND METHODS: MIC of vancomycin, linezolid, and daptomycin were determined by E-test in 198 MRSA isolates and their MIC 50, MIC 90, and geometric mean MIC were calculated. RESULTS: While all isolates were sensitive to vancomycin, linezolid, and daptomycin, MIC 90 of vancomycin increased from 1.5 µg/ml in 2015 to 2 µg/ml in 2016. The percentage of isolates with vancomycin MIC >2 µg/ml doubled in 2016 (12.9%) as compared to 2015 (6.1%). MIC 90 for linezolid remained steady as 3 µg/ml, but geometric mean MIC increased from 2.20 µg/ml in 2015 to 2.29 µg/ml in 2016, and more than 40% isolates showed MIC 3 µg/ml. MIC 90 and geometric mean MIC of daptomycin decreased from 0.75 µg/ml to 0.5 µg/ml and 0.50 µg/ml to 0.36 µg/ml in 2015 and 2016, respectively. CONCLUSION: MIC creep was observed with vancomycin. Although linezolid MIC was within the susceptible zone, more than 40% strains showing MIC 3 µg/ml may herald the future development of either resistant or heteroresistant. Daptomycin showed good sensitivity against MRSA isolates. Therefore, it could be considered as an alternative agent for the treatment of infections caused by MRSA. However, it should be reserved where this class has a clear therapeutic advantage over other anti-MRSA drugs.


Author(s):  
Chanhyeon Park ◽  
Dong Hoo Lee ◽  
Sung Yool Park ◽  
Do Hun Kim

Membranous croup is a rare disease that is characterized by diffuse inflammation of the larynx, trachea, and bronchi with adherent or semiadherent mucopurulent membranes in the subglottic trachea and larynx. All cases have occurred in children and there has been no case of adults. The clinical signs, symptoms, progress and prognosis of membranous croup are more severe than those of ordinary croup. The detached membrane in membranous croup may cause a high degree of air way obstruction and give similar characteristics of laryngeal diphtheria, thus it is important to differentiate it from diphtheria by identifying the pathogen. Herein we report with a review of literature a rare case of adult membranous croup caused by methicillin-resistant staphylococcus aureus mimicking laryngeal diphtheria.


1991 ◽  
Vol 12 (01) ◽  
pp. 29-35 ◽  
Author(s):  
Henry F. Chambers

AbstractThe mechanism of methicillin resistance confers resistance to all available B-lactam antibiotics; consequently, B-lactam antibiotics have no role in therapy of methicillin-resistant Staphylococcus aureus (MRSA) infections. Vancomycin remains the drug of choice. Teicoplanin and daptomycin are two investigational antibiotics related to vancomycin in structure and in spectrum of activity. In clinical trials employing relatively low doses, neither was as effective as vancomycin. Trials at higher doses are on-going. Quinolones, ciprofloxacin in particular, have been used successfully to treat infections caused by MRSA; however, the usefulness of quinolones may be limited by the tendency of resistance to emerge during therapy. Quinolones probably should be used only in combination with another active agent, such as rifampin, when treating serious infections caused by MRSA. Other agents may be active in vitro against MRSA, but clinical data showing their effectiveness are lacking. Rifampin combination regimens appear most effectively to eradicate colonization with MRSA.


2004 ◽  
Vol 8 (18) ◽  
Author(s):  
A Johnson

The glycopeptide vancomycin is, for many, currently the drug of choice for treating infections due to methicillin-resistant Staphylococcus aureus (MRSA)


1986 ◽  
Vol 96 (3) ◽  
pp. 419-423 ◽  
Author(s):  
W. Y. Lau ◽  
C. H. Teoh-Chan ◽  
S. T. Fan ◽  
K. F. Lau

SUMMARYFive hundred strains of methicillin-resistant Staphylococcus aureus were tested against various anti-staphylococcal agents. Vancomycin, fusidic acid and fosfomycin were found to be the most effective. Only 1 strain out of 500 was resistant to fosfomycin. Three patients with methicillin-resistant Staphylococcus aureus septicaemia were successfully treated by fosfomycin. We conclude that fosfomycin could be the drug of choice for methicillin-resistant Staphylococcus aureus infection.


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