Vancomycin-resistant Staphylococcus aureus overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Vancomycin-resistant Staphylococcus aureus (VRSA) is a strain of Staphylococcus aureus that has become resistant to the glycopeptide antibiotic vancomycin. With the increase of staphylococcal resistance to methicillin, vancomycin (or teicoplanin) is often a treatment of choice in infections with methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin resistance is still a rare occurrence. Unfortunately, VRSA may also be resistant to meropenem and imipenem, two other antibiotics that can be used in sensitive staphylococcus strains. Even with the absence of high-level resistance to vancomycin, another concern posed by the presence of VISA (vancomycin-intermediate Staphylococcus aureus) is the increased difficulty in prescribing treatments, especially in situations where an effective treatment for an infection is needed urgently, before detailed resistance profiles can be obtained. In hospitals already endemic with multiresistant MRSA, the appearance of VRSA would make the treatment of infected patients much more difficult. At present, high-level resistances to both glycopeptide and β-lactam antibiotics in Staphylococcus aureus seem to be mutually exclusive, in that both resistances are not seen at once in the same strain of bacterium. However, this is not due to a fundamental biochemical incompatibility. Theoretically, a superbug displaying high-level resistances to both classes of antibiotics could evolve given the current selective environment. VISA and VRSA are specific types of antimicrobial-resistant staph bacteria. While most staph bacteria are susceptible to the antimicrobial agent vancomycin, some have developed resistance.

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