MRSA Infections: Even Vancomycin Isn’t Working Any Longer

MRSA Kills

TAKE-HOME POINTS

■ Vancomycin had been the drug of choice for the treatment of methicillin- resistant (MRSA) infections for many years; however, recently its efficacy has been compromised.

■ Decreasing vancomycin suscepti­bilities, increasing incidence of MRSA in­fections, and emergence of vancomycin-intermediate and vancomycin-resistant strains leading to clinical failures have made it necessary to reevaluate the options for the treatment of serious MRSA infections.

■ Consideration of alternative drugs for the treatment of MRSA infections is warranted when deciding upon the appropriate antimicrobial therapy.

Methicillin-resistant Staph­ylococcus aureus (MRSA) is a frequent cause of serious infections, such as pneumonia, bacteremia, endocarditis, and osteomyelitis. The incidence of MRSA infections has changed in the past 20 years, with 
an increase in hospital-acquired MRSA 
infections worldwide and the emergence of a growing number of community-acquired MRSA infections.1 For many decades, IV vancomycin has been the drug of choice for the treatment of these infections.2 However, the emergence of clinical isolates of MRSA with reduced vancomycin susceptibilities and reports of clinical failures with vancomycin, despite appropriate therapeutic doses, have created the need for considering alternative drugs.3

CHANGES IN MRSA 
SUSCEPTIBILITY

Although MRSA was first isolated in 1961, it did not become a worldwide problem until the 1970s. Its emergence as a frequent pathogen led to increased use of vancomycin. A glycopeptide with antistaphylococcal activity, vancomycin disrupts cell wall synthesis and arrests bacterial growth. Vancomycin rapidly became the mainstay for the treatment of beta-lactam-resistant gram-positive infections, especially those due to MRSA.2 By 2003, however, reports began to appear of clinical failures with vancomycin therapy of infections caused by susceptible MRSA strains.4 Since then, many similar reports have been published in which vancomycin-susceptible MRSA strains were identified and clinical failures resulted despite monitoring and maintenance of trough concentrations in a range previously thought to predict clinical success.5

Susceptibility of a microorganism to a specific antimicrobial drug is determined by the mean inhibitory concentration (MIC), the lowest concentration of the drug that inhibits the visible growth of the microorganism after an overnight in vitro incubation. The lower the MIC, the more susceptible the microorganism. Previously, MRSA strains were considered susceptible to vancomycin if their growth was inhibited at an MIC of 4 µg/mL or less. Susceptibility breakpoints for vancomycin were established by the Clinical and Laboratory Standards Institute (CLSI) more than 25 years ago. Improved methods of detection and a growing body of clinical data resulted in a decrease in the vancomycin susceptibility breakpoint to 2 µg/mL or less in 2006.6 More recently, reports have demonstrated clinical failures with therapeutic doses of vancomycin for bacteremias and pneumonias due to vancomycin-susceptible MRSA strains for which the MIC was 2 µg/mL or less. This disturbing trend has led many to suggest that the time has come to redefine the MIC cutoff point even lower.5

Initially, MRSA infections were almost exclusively hospital-acquired. MRSA now accounts for about 60% of clinical isolates of S aureus strains found in ICUs in the United States.7 The nosocomial connection to MRSA infections was clearly established, but in the past decade, community outbreaks, including bacteremias and skin and soft tissue infections, began to appear. Through DNA sequence analysis, the origin of most of these emerging community strains was traced to hospital or long-term care facilities. Over time, there has been an incremental increase in the observed vancomycin MICs of clinical isolates of susceptible MRSA. Referred to as MIC creep, this increase has been correlated with clinical failures in the treatment of MRSA infections.8

BACTERICIDAL VS INHIBITORY 
CONCENTRATIONS

Use of an antimicrobial agent with bactericidal activity has been a long-standing concept for treatment of serious MRSA infection, but not all strains of MRSA exhibit a bactericidal response when exposed to vancomycin. Minimum bactericidal concentration (MBC) is the lowest drug concentration that kills a microorganism. Vancomycin tolerance is defined as an MBC:MIC ratio greater than 32. Such tolerance has been reported in up to 15% of wild-type MRSA strains with vancomycin-susceptible MICs; however, the poor bactericidal activity of vancomycin in these strains poses a potential risk for clinical failure.3 Although the clinical significance of vancomycin tolerance is not fully understood, it has been associated with clinical failures observed in gram-positive infections of cancer patients.9

In addition to rising MICs and clinical failures with vancomycin-susceptible MRSA strains, diminished or even resistant strains have emerged in the past 15 years. Vancomycin-intermediate S aureus (VISA) was first observed in Japan in 1997. Originally set at 8 µg/mL, the vancomycin breakpoint MIC for VISA was lowered by the CLSI in 2006 to the current value of 4 to 8 µg/mL.6 Vancomycin tolerance has been observed in up to 74% of VISA strains.3 Vancomycin-resistant S aureus (VRSA) was identified in the United States in 2002. The CLSI lowered the vancomycin breakpoint MIC of VRSA from its original value of 32 µg/mL or greater to 16 µg/mL or greater.6 Vancomycin tolerance or frank resistance is seen in 100% of VRSA strains.3 Fortunately, the incidence of VRSA has remained low.10

The authors work in the Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M.D. Anderson Cancer Center, Houston. Roy Borchardt is a physician assistant and the department editor, and Ken Rolstonis a professor of medicine. The authors have indicated no relationships to disclose relating to the content of this article.

Natural Alternative found that kills MRSA

 MRSA is killing more people than AIDS!  

It is rampant in hospitals, gyms and within the community.  Most antibiotics are no longer effective against this kind of Staph infection, so medical science is frantically searching for a non-toxic solution.  In FDA-certified independent in-vitro lab tests, NutraSilver killed 1.33 billion cells of MRSA in 60 seconds at the rate of 99.9999% with only one drop. If you took MRSA Staph bacterium the same amount of MRSA and placed it in a vat of antibiotics, nothing would happen!  MRSA does not care about Methicillin or Vancomyacin any longer!

Different Approach, Better Results

They are trying to turn off MRSA’s ability to reproduce with antibiotics; we have succeeded by switching of MRSA’s ability to breath! You can read the entire lab report here.

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About CareMan
I am the CareMan, have been for 7 years now. I really do care about YOU and getting YOU back to great, natural health, so long as you have an open mind.

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