Drugs

, Volume 61, Issue 1, pp 1–7 | Cite as

Emergence of Methicillin-Resistant Staphylococcus aureus with Intermediate Glycopeptide Resistance

Clinical Significance and Treatment Options
Current Opinion

Abstract

Methicillin-resistant Staphylococcus aureus is a pathogen that is associated with serious infections that pose a significant risk of morbidity and mortality because of their multidrug resistant nature. Until recently, therapeutic options were limited to vancomycin, making the use of this drug widespread. Unfortunately, the continued application of this drug has led to the emergence of glycopeptide intermediate susceptible S. aureus (GISA). By definition, these organisms demonstrated a vancomycin minimum inhibitory concentration (MIC) of >4 mg/L and <32 mg/L. However, although the mechanism of resistance is not fully elucidated at this time, GISA strains have demonstrated thickened or aggregated cell walls, an increase in penicillin binding proteins and greater autolytic activity. At present, the overall number of reported cases of GISA is relatively low. In most cases, thus far, prolonged courses of vancomycin were reported. A few cases reported monitoring serum vancomycin concentrations but because of limited information, no association with outcome can be made. Whether these GISA strains will become more widespread or evolve into fully glycopeptide resistant strains is unknown at this time. Although there are a number of new agents that possess activity against these pathogens, there is no consensus regarding specific recommendations for treatment. Strict infection control practices, routine screening for resistance and controlled use of antibacterial agents, especially vancomycin, are critical steps in preventing the further development of resistance among staphylococci.

Keywords

Minimum Inhibitory Concentration Vancomycin Glycopeptide Linezolid Teicoplanin 

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Copyright information

© Adis International Limited 2001

Authors and Affiliations

  1. 1.Wayne State University and The Anti-Infective Research Laboratory, Department of Pharmacy ServicesDetroit Receiving Hospital and University Health CenterDetroitUSA
  2. 2.Department of Pharmacy PracticeTexas Tech University, Health Science Center, School of PharmacyAmarilloUSA

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