Another Brick in the Wall

From the joint annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America, Washington
 
Add another brick in the wall of MRSA drug resistance.  Today Dr. Miguel Sanchez reported on an outbreak of linezolid-resistant MRSA this year at the Hospital Clinico San Carlos in Madrid during a press conference and again at a slide presentation. Linezolid (Zyvox) is one of the oxazolidinone class of antibiotics.
 
The outbreak lasted from April through June and involved 12 ICU patients. The hospital staff managed to contain the outbreak by stepping up surveillance, isolating patients, and by revisiting their use of linezolid. Subsequent use of linezolid was limited to either documented or suspected cases of respiratory tract MRSA infections. As a result, use of linezolid at the hospital dropped from 202 defined daily doses in the month of April to 25 DDDs in July.
 
Dr. Robert S. Daum, who is a pediatric infectious diseases specialist at the University of Chicago, was also present during the press session. He noted that linezolid-resistant MRSA has been seen in the United States but it’s been very rarely sighted. He attributed this to antibiotic stewardship programs at many U.S. hospitals. “In our hospital, we have a very tight grip on linezolid use.” The drug can only be prescribed with the approval of an infectious disease specialist. Limiting use of the drug limits chances for an organism to develop resistance.

 

 

This experience in Spain, contrasted with that in Chicago, points to the importance of antibiotic stewardship. S. aureus is a pretty smart bug that adapts pretty rapidly to whatever we throw at it.  A large part of reducing antibiotic resistance seems to be choosing carefully what and how much of it we throw at infections.

 

Image by flickr user Morula used under a creative commons license.

 

—Kerri Wachter

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Filed under Hospital and Critical Care Medicine, Infectious Diseases, Internal Medicine, Pediatrics

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