Vancomycin-Resistant Staphylococcus Aureus (VRSA): Difference between revisions
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== Introduction == | == Introduction == | ||
[[File:Staphylococcus aureus VISA.jpg|thumb|400x400px|Under a very high magnification of 50,000x, this scanning electron micrograph (SEM) shows a strain of Staphylococcus aureus bacteria taken from a vancomycin intermediate resistant culture (VISA).|alt=]] | [[File:Staphylococcus aureus VISA.jpg|thumb|400x400px|Under a very high magnification of 50,000x, this scanning electron micrograph (SEM) shows a strain of Staphylococcus aureus bacteria taken from a vancomycin intermediate resistant culture (VISA).|alt=]] | ||
Bacteria may sometimes evolve to become resistant to antibiotics. Whenever this occurs, these new bacteria are called "antibiotic resistant". Over time, staph | Bacteria may sometimes evolve to become resistant to antibiotics. Whenever this occurs, these new bacteria are called "antibiotic resistant". ''Staphylococcus aureus'', also known as "staph", is a common type of bacteria that is often found on the skin and in the nose of healthy, asymptomatic people.<ref name=":0" />Over time, staph bacteria have become difficult to treat with certain types of antibiotics, including vancomycin and [[Methicillin-Resistant Staphylococcus Aureus|methicillin]].<ref name=":0">https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/vancomycin-intermediate-staphylococcus-aureus-visa-and-vancomycin-resistant-staphylococcus-aureus-vrsa-infections/?TSPD_101_R0=5b67e3c62340690422428653d26c0331v500000000000000000c73c106cffff000000000000000000000000000061d7461400b5bf837508a442c88dab2000285a6d2e016d91363242431de1ecef2901c747187b70441b18c8b646ce1c3c2808a3fca0230a2800a4557575aea6cc3042c56a5bface216f3122e7cd49a522be9ebeac071b6e748c19a967ef67592485</ref> Vancomycin-resistant ''Staphylococcus aureus'' (VRSA) is a type of antimicrobial-resistant bacteria that was first reported in the US in 2002.<ref name=":1">https://www.cdc.gov/hai/organisms/visa_vrsa/visa_vrsa.html</ref><ref name=":2">McGuinness WA, Malachowa N, DeLeo FR. Vancomycin Resistance in ''Staphylococcus aureus''
. ''Yale J Biol Med''. 2017;90(2):269-281. Published 2017 Jun 23.</ref> | ||
Vancomycin-intermediate S. aureus (VISA) bacteria are moderately resistant to antibiotics, while VRSA bacteria are strongly resistant to antibiotics.<ref name=":0" /> | Vancomycin-intermediate ''S. aureus'' (VISA) bacteria are moderately resistant to antibiotics, while VRSA bacteria are strongly resistant to antibiotics.<ref name=":0" />The total number of human VRSA infections to date is only 14 known in the US. <ref name=":2" />Most of these strains have been isolated in hospitalized patients, but there have been a few cases reported from the community.<ref name=":3">Loomba PS, Taneja J, Mishra B. Methicillin and Vancomycin Resistant S. aureus in Hospitalized Patients. ''J Glob Infect Dis''. 2010;2(3):275-283. </ref> | ||
With the discovery of penicillin in 1941, infectious disease, including those caused by ''S. aureus'' became treatable through antibiotics. However, the bacteria ''S. aureus'' developed rapid antibiotic resistance only a few years after the first use of penicillin (PRSA).<ref name=":2" /> In the late 1950s, Methicillin was introduced as a therapy for PRSA infections. In a similar cycle to penicillin, the first [[Methicillin-Resistant Staphylococcus Aureus|MRSA]] strains were reported within two years of clinical use. Vancomycin was then introduced as a therapy for MRSA infections in hospital settings in the 1980s.<ref name=":2" /> | |||
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== Pathological Process == | == Pathological Process == | ||
VRSA bacteria are spread by direct person-to-person contact, usually on hands. VRSA bacteria may also spread by contact with VRSA-contaminated items, such as bandages, medical equipment, or surfaces. VRSA exposure does not guarantee illness. People who have been exposed to VRSA bacteria may carry the bacteria on their skin or in their nose and may not get sick at all, or may get sick from VRSA days, weeks, or months later.<ref name=":0" /> | |||
VRSA | VRSA strains have been found to have thicker cell walls that strains vulnerable to vancomycin.<ref name=":3" />Vancomycin in VRSA bacteria is trapped in the out layers of the cell wall and sequestered by the bacteria, not deactivated. <ref name=":3" /> | ||
== Risk Factors == | == Risk Factors == | ||
Patients with the following conditions are at higher risk for VRSA infection:<ref name=":0" /> | Patients with the following conditions are at higher risk for VRSA infection:<ref name=":0" /> | ||
* Co-morbid conditions (ex. diabetes | * Co-morbid conditions (ex. diabetes, kidney disease, gangrenous wound or surgical wound)<ref name=":4">Cong Y, Yang S, Rao X. Vancomycin resistant ''Staphylococcus aureus'' infections: A review of case updating and clinical features. ''J Adv Res''. 2019;21:169-176. Published 2019 Oct 12. </ref> | ||
* Previous infection with [[Methicillin-Resistant Staphylococcus Aureus|MRSA]] | * Previous infection with [[Methicillin-Resistant Staphylococcus Aureus|MRSA]] | ||
* Recent hospitalization | * Recent hospitalization | ||
* Tubes going into the body (ex. catheter) | * Tubes going into the body (ex. catheter) | ||
* Recent use of vancomycin or other antibiotics | * Recent use of vancomycin or other antibiotics, especially glycopeptides<ref name=":3" /> | ||
* Antibiotic use in hospitals, agriculture, fisheries, and animal husbandry<ref name=":3" /> | |||
== Clinical Presentation == | == Clinical Presentation == | ||
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== Management / Interventions<br> == | == Management / Interventions<br> == | ||
If a patient suspects they have a VRSA infection or has been exposed to VRSA, they should immediately contact their healthcare provider. | If a patient suspects they have a VRSA infection or has been exposed to VRSA, they should immediately contact their healthcare provider. | ||
Aspects of VRSA management involve systemic antimicrobial therapy, wound care (as wounds provide environments for co-infection and co-colonization of MRSA), and proper patient management such as patient isolation, contact tracing, and notification to infection control and local health authorities.<ref name=":4" /> | |||
As of 2010, VRSA is treatable with several FDA-approved drugs. <ref name=":1" />< | As of 2010, VRSA is treatable with several FDA-approved drugs. <ref name=":1" />These antimicrobial drugs include quinupristin-dalfopristin and linezolid that act against drug-resistant strains of ''S. aureus.'' Another bactericidal agent, Daptomycin, is undergoing clinical trials.<ref name=":3" /> | ||
== Prevention == | == Prevention == | ||
Use of personal protective equipment (PPE) and appropriate hand hygiene by healthcare personnel can reduce the spread of VRSA.<ref name=":1" / | Preventing the emergence of VRSA/VISA requires a comprehensive approach that includes administrative involvement and measure (e.g. nurse staffing, communication systems, procedures for infection control), education and training of all healthcare personnel, and judicious, rational antibiotic use.<ref name=":3" /> Use of personal protective equipment (PPE) and appropriate hand hygiene by healthcare personnel can also reduce the spread of VRSA.<ref name=":1" /> | ||
== References == | == References == | ||
<references /> | <references /> | ||
[[Category:Communicable Diseases]] | [[Category:Communicable Diseases]] | ||
Revision as of 22:59, 6 January 2022
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Introduction[edit | edit source]
Bacteria may sometimes evolve to become resistant to antibiotics. Whenever this occurs, these new bacteria are called "antibiotic resistant". Staphylococcus aureus, also known as "staph", is a common type of bacteria that is often found on the skin and in the nose of healthy, asymptomatic people.[1]Over time, staph bacteria have become difficult to treat with certain types of antibiotics, including vancomycin and methicillin.[1] Vancomycin-resistant Staphylococcus aureus (VRSA) is a type of antimicrobial-resistant bacteria that was first reported in the US in 2002.[2][3]
Vancomycin-intermediate S. aureus (VISA) bacteria are moderately resistant to antibiotics, while VRSA bacteria are strongly resistant to antibiotics.[1]The total number of human VRSA infections to date is only 14 known in the US. [3]Most of these strains have been isolated in hospitalized patients, but there have been a few cases reported from the community.[4]
With the discovery of penicillin in 1941, infectious disease, including those caused by S. aureus became treatable through antibiotics. However, the bacteria S. aureus developed rapid antibiotic resistance only a few years after the first use of penicillin (PRSA).[3] In the late 1950s, Methicillin was introduced as a therapy for PRSA infections. In a similar cycle to penicillin, the first MRSA strains were reported within two years of clinical use. Vancomycin was then introduced as a therapy for MRSA infections in hospital settings in the 1980s.[3]
Pathological Process[edit | edit source]
VRSA bacteria are spread by direct person-to-person contact, usually on hands. VRSA bacteria may also spread by contact with VRSA-contaminated items, such as bandages, medical equipment, or surfaces. VRSA exposure does not guarantee illness. People who have been exposed to VRSA bacteria may carry the bacteria on their skin or in their nose and may not get sick at all, or may get sick from VRSA days, weeks, or months later.[1]
VRSA strains have been found to have thicker cell walls that strains vulnerable to vancomycin.[4]Vancomycin in VRSA bacteria is trapped in the out layers of the cell wall and sequestered by the bacteria, not deactivated. [4]
Risk Factors[edit | edit source]
Patients with the following conditions are at higher risk for VRSA infection:[1]
- Co-morbid conditions (ex. diabetes, kidney disease, gangrenous wound or surgical wound)[5]
- Previous infection with MRSA
- Recent hospitalization
- Tubes going into the body (ex. catheter)
- Recent use of vancomycin or other antibiotics, especially glycopeptides[4]
- Antibiotic use in hospitals, agriculture, fisheries, and animal husbandry[4]
Clinical Presentation[edit | edit source]
Diagnostic Procedures[edit | edit source]
Staph bacteria is identified as VRSA based on laboratory testing. These tests determine the minimum inhibitory concentration (MIC) of an antimicrobial agent that inhibit the Staph bacteria growth. Staph bacteria are classified as VRSA if the MIC is ≥16μg/mL.[2]
Management / Interventions
[edit | edit source]
If a patient suspects they have a VRSA infection or has been exposed to VRSA, they should immediately contact their healthcare provider.
Aspects of VRSA management involve systemic antimicrobial therapy, wound care (as wounds provide environments for co-infection and co-colonization of MRSA), and proper patient management such as patient isolation, contact tracing, and notification to infection control and local health authorities.[5]
As of 2010, VRSA is treatable with several FDA-approved drugs. [2]These antimicrobial drugs include quinupristin-dalfopristin and linezolid that act against drug-resistant strains of S. aureus. Another bactericidal agent, Daptomycin, is undergoing clinical trials.[4]
Prevention[edit | edit source]
Preventing the emergence of VRSA/VISA requires a comprehensive approach that includes administrative involvement and measure (e.g. nurse staffing, communication systems, procedures for infection control), education and training of all healthcare personnel, and judicious, rational antibiotic use.[4] Use of personal protective equipment (PPE) and appropriate hand hygiene by healthcare personnel can also reduce the spread of VRSA.[2]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/vancomycin-intermediate-staphylococcus-aureus-visa-and-vancomycin-resistant-staphylococcus-aureus-vrsa-infections/?TSPD_101_R0=5b67e3c62340690422428653d26c0331v500000000000000000c73c106cffff000000000000000000000000000061d7461400b5bf837508a442c88dab2000285a6d2e016d91363242431de1ecef2901c747187b70441b18c8b646ce1c3c2808a3fca0230a2800a4557575aea6cc3042c56a5bface216f3122e7cd49a522be9ebeac071b6e748c19a967ef67592485
- ↑ 2.0 2.1 2.2 2.3 https://www.cdc.gov/hai/organisms/visa_vrsa/visa_vrsa.html
- ↑ 3.0 3.1 3.2 3.3 McGuinness WA, Malachowa N, DeLeo FR. Vancomycin Resistance in Staphylococcus aureus . Yale J Biol Med. 2017;90(2):269-281. Published 2017 Jun 23.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Loomba PS, Taneja J, Mishra B. Methicillin and Vancomycin Resistant S. aureus in Hospitalized Patients. J Glob Infect Dis. 2010;2(3):275-283.
- ↑ 5.0 5.1 Cong Y, Yang S, Rao X. Vancomycin resistant Staphylococcus aureus infections: A review of case updating and clinical features. J Adv Res. 2019;21:169-176. Published 2019 Oct 12.
