Staph
infections show first
sign of resistance
to long-reliable drug.
The
staph infection, once a common killer in hospitals before
the advent of antibiotics, has shown the first signs of developing
resistance to a last-line drug that until now has always
prevailed.
A federal agency on Wednesday confirmed that it has documented the first partial
failure of vancomycin, which for more than a quarter century has cured staph
infections when other antibiotics failed.
The infant who acquired the staph infection, a child in Japan recovering heart
surgery, ultimately conquered the infection with a very high dose of vancomycin
along with other antibiotics.
Yet experts consider the event a medical milestone. In the ongoing battle against
infections, inappropriate use of microbe killers has given the bugs an opening
to evolve their way around the antibiotics.
"Maybe this will be a warning shot across the bow," said Dr. Jon Rosenberg, a
state public health official who monitors hospital-acquired infections.
If further tests show the organism that caused the infection in Japan is likely
spreading, "it is the first direct hit," he said.
The bacterium in question is staphylococcus aureus. It lives harmlessly on perhaps
10 percent of the population's skin. Infections happen when the bacteria manage
to get into the bloodstream. And in hospitals, that can happen as an inadvertent
side effect of a surgeon's scalpel.
Hospitals routinely administer antibiotics to patients before surgery as a precautionary
measure to battle any resulting infection.
Rosenberg of the California Department of Health Services got his first hints
of the unprecedented Japan vancomycin case in a very '90s fashion -- surfing
the Internet. There on an electronic message exchange used mostly by scientists,
someone had posted word of the Japan incident and sought more information.
Officials at the federal Centers for Disease Control and Prevention, meanwhile,
hadn't publicly announced the event. Instead, they were opting for the traditional
way of announcing such developments -- by submitting an article to a medical
journal. That process typically takes months.
This first case of a staph infection resistant to vancomycin "is something that
we in CDC and most people in medicine have been expecting for some time," said
Tom Skinner of the CDC.
CDC officials in recent years have been busy monitoring the decline in antibiotics
against a variety of infections. Drug-resistant bacteria, for example, now cause
an estimated 1 million ear infections a year, mostly in children.
Just eight years ago, vancomycin failed only 0.3 percent of the time in treating
infections caused by a family of bacteria called enterococci. Within four years,
the failure rate jumped 26-fold, to 7.9 percent.
As a health problem, an enterococcus infection "is a minor-league pathogen that
has a major-league (antibiotic) resistance," said Dr. Stuart Cohen, clinical
director of the department of epidemiology and control at the UC Davis Medical
Center.
Drug-resistant staph infections, however, would be more serious. Staph bacteria
are the top cause of hospital infections, accounting for about 13 percent of
the nation's 2 million hospital infections each year, according to the CDC. Before
antibiotics, "people used to get boils or skin infections and die," Rosenberg
said.
That is why a single case of a vancomycin-resistant staph infection in Japan
is creating such a stir among infection experts. When Cohen attended a conference
of infectious disease experts last month in St. Louis, "this was the hubbub," he
said.
Experts like Cohen anxiously await more details. Unclear, for example, is whether
this single case involves genetic mutations that signal that the bacteria can
easily transfer its resistance, Rosenberg said.
Also unknown is whether staph infections will begin to resist vancomycin yet
remain vulnerable to other antibiotics, said Dr. Anvar Velji, chief of infectious
diseases at Kaiser-Permanente's South Sacramento Medical Center.
By
Tom Philp, Bee Medical Writer
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