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Ideas and Opinions |1 February 1996

Vancomycin-Resistant Staphylococcus aureus: Perspectives on Measures Needed for Control

Michael B. Edmond, MD, MPH; Richard P. Wenzel, MD, MSc; A. William Pasculle, ScD

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Copyright ©2004 by the American College of Physicians
2004
  • From Medical College of Virginia and Virginia Commonwealth University, Richmond, Virginia; and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Requests for Reprints: Michael B. Edmond, MD, MPH, Medical College of Virginia, PO Box 980019, Richmond, VA 23298-0019. Current Author Addresses: Dr. Edmond: Medical College of Virginia, Division of Quality Health Care, PO Box 980019, Richmond, VA 23298-0019.
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Throughout recorded history, humans have been prey to infections caused by virulent strains of staphylococci and streptococci. The advent of the antibiotic era—50 years ago—brought with it great optimism about the control of Staphylococcus aureus and Streptococcus pyogenes. Fortunately, despite five decades of penicillin use, all strains of Streptococcus pyogenes remain very susceptible to penicillin.
The story of S. aureus is more complex. By the late 1950s, almost 50% of all strains were resistant to penicillin. The organism had developed the ability to break the β-lactam ring by producing a β-lactamase referred to as penicillinase. In 1960, however, methicillin—a penicillinase-resistant β-lactam effective for treating penicillin-resistant S. aureus—was discovered. The subsequent availability of oral cephalosporins added greatly to outpatient management of infections caused by this organism.
Methicillin-resistant strains of staphylococci emerged by the late 1970s and have become increasingly more prevalent as nosocomial pathogens. The medical community was comforted by the fact that vancomycin—available since 1958—provided effective therapy for all strains of methicillin-resistant S. aureus. Nevertheless, the emergence of vancomycin-resistant strains of coagulase-negative staphylococci [1, 2] caused concern that such observations might presage similar developments in S. aureus. Adding to these concerns were observations that 1) vancomycin-resistant enterococci caused isolated infections or epidemics in some U.S. hospitals and were becoming increasingly prevalent in critical care units [3, 4]; and 2) high-level vancomycin resistance was experimentally transferred from Enterococcus faecalis to S. aureus in both in vitro and in vivo models [5].
It seems likely that...
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Edmond MB, Wenzel RP, Pasculle AW. Vancomycin-Resistant Staphylococcus aureus: Perspectives on Measures Needed for Control. Ann Intern Med. 1996;124:329–334. doi: https://doi.org/10.7326/0003-4819-124-3-199602010-00008

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Published: Ann Intern Med. 1996;124(3):329-334.

DOI: 10.7326/0003-4819-124-3-199602010-00008

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