Nurseweek/Healthweek

CDC confirms two more cases of drug-resistant staph infection

posted 9-15-97

The national Centers for Disease Control and Prevention (CDC) early this month confirmed the third documented case of staphylococcus infection worldwide to show partial resistance to vancomycin, the last uniformly effective antimicrobial treatment available. The discovery coincides with new research indicating that physicians often overprescribe the last-line-of-defense drug.

The latest case, involving a New Jersey patient, is the second in the United States. Researchers had already documented instances of the drug-resistant bacteria in Michigan and in Japan. In all three cases, patients did not respond to a strict course of vancomycin, but ultimately beat the infection with a combination of antibacterial drugs.

Although the strain discovered in the latest case was not fully resistant to vancomycin, CDC officials said the finding "increases the possibility that levels of resistance will eventually develop which could make many infections untreatable" and described the development as "serious, but expected."

Staph bacteria cause about 260,000 cases of infection in U.S. hospitals each year. Vancomycin may be going the same route as penicillin, which hospitals first reported as ineffective against some strains of bacteria in the 1950s. Twenty years later, the more potent methicillin also partially failed.

Health experts say the recent cases of vancomycin resistance do not constitute a public health risk, but serve as a warning that overuse of the drug could be speeding up the evolution of resistant organisms. In a study directed by the Health Care Financing Administration (HCFA), researchers reviewed more than 7,000 patient records at 131 East Coast hospitals and found that 63 percent of orders for vancomycin violated CDC guidelines. HCFA officials said physicians tend to lean on the catch-all drug rather than waiting up to 72 hours for a lab to culture potentially fatal microbes.

In response to the emergence of vancomycin resistance in the United States, the CDC is urging healthcare workers to step up infection-control measures, such as hand washing, and admonishing physicians to use vancomycin prudently. Additionally, the Food and Drug Administration is targeting alternatives to vancomycin for rapid development.