Journal Article

Adaptation of Methicillin-Resistant <i>Staphylococcus aureus</i> in the Face of Vancomycin Therapy

George Sakoulas, Robert C. Moellering and George M. Eliopoulos

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 42, issue Supplement_1, pages S40-S50
Published in print January 2006 | ISSN: 1058-4838
Published online January 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/491713
Adaptation of Methicillin-Resistant Staphylococcus aureus in the Face of Vancomycin Therapy

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For the past 2 decades, vancomycin has served as the cornerstone of therapy against serious methicillin-resistant Staphylococcus aureus infections. This role is increasingly challenged by questions of efficacy, including reduced efficacy against infections caused by glycopeptide-intermediate S. aureus strains. In an evaluation of clinical glycopeptide-intermediate S. aureus isolates and serial, clinical methicillin-resistant S. aureus isolates obtained from patients receiving vancomycin for the treatment of bacteremia, we found that loss of function of the accessory gene regulator operon may confer a survival advantage to S. aureus under vancomycin selection pressure, particularly in strains with the accessory gene regulator group II genotype. Other advantages in a nosocomial setting may include enhancement of biofilm formation and promotion of physiologic changes supporting colonization. We conclude that loss of accessory gene regulator function in methicillin-resistant S. aureus might, in part, explain the decreased efficacy of vancomycin in the therapy of methicillin-resistant S. aureus bacteremia, thus highlighting the need to reevaluate the criteria of susceptibility to vancomycin.

Journal Article.  7302 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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