MRSA - Staphylococcus aureus with Methicillin resistance, should now be re-named VRSA. Vancomycin being the last treatment used to cure MRSA infection and the latest drug that the Staph aureus bacterium has overcome.
Vancomycin-resistant staphylococcus aureus were once very rare. After Methicillin, Vancomycin had long been considered the gold standard for the treatment and cure of MRSA infections.
Despite its in-vitro capability, when Vancomycin is now used as a single drug treatment to try and cure MRSA infections, cure rates in serious infections have become very disappointing. So much so, that most medical practitioners will no longer advise its use. Another antibiotic drug has become obsolete...
*Sakoulas* has reported more than a 46% failure rate in treating bacteraemia in 2006.
Quote from Medline...
Adaptation of methicillin-resistant Staphylococcus aureus in the face of vancomycin therapy. Sakoulas G, Moellering RC Jr, Eliopoulos GM. Westchester Medical Center, Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595, USA. firstname.lastname@example.org
"For the past 2 decades, vancomycin has served as the cornerstone of therapy against serious methicillin-resistant Staphylococcus aureus infections. This role is increasingly challenged by questions of efficacy, including reduced efficacy against infections caused by glycopeptide-intermediate Staph aureus strains. In an evaluation of clinical glycopeptide-intermediate Staph aureus isolates and serial, clinical methicillin-resistant Staph aureus isolates obtained from patients receiving vancomycin for the treatment of bacteraemia, we found that loss of function of the accessory gene regulator operon may confer a survival advantage to Staph aureus under vancomycin selection pressure, particularly in strains with the accessory gene regulator group II genotype. Other advantages in a nosocomial setting may include enhancement of biofilm formation and promotion of physiologic changes supporting colonization. We conclude that loss of accessory gene regulator function in methicillin-resistant Staph aureus might, in part, explain the decreased efficacy of vancomycin in the therapy of methicillin-resistant Staph aureus bacteraemia, thus highlighting the need to reevaluate the criteria of susceptibility to vancomycin."
PMID: 16323119 [PubMed - indexed for MEDLINE]
Moise and Schentag have also shown 40% failures in treating lower respiratory-tract infections.
"Treatment failures with vancomycin may occur fairly commonly even with vancomycin-susceptible Staph aureus (VSSA) strains. Moise and Schentag reviewed 23 cases of vancomycin treatment failures in lower respiratory tract Staph aureus infections, representing a treatment failure rate of 40% in their institution over a 1-year period. In each case, the vancomycin MIC for the organism was within the susceptible range and the vancomycin concentration in serum was shown to be in the therapeutic range. Several of these patients received multiple courses of vancomycin as their infections relapsed upon discontinuation of the antibiotic."
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