title: Genesis of methicillin-resistant Staphylococcus aureus (MRSA), how treatment of MRSA infections has selected for vancomycin-resistant Enterococcus faecium, and the importance of antibiotic management and infection control.
abstract: We extensively studied the epidemiology and time course of endemic methicillin-resistant Staphylococcus aureus (MRSA) in the Millard Fillmore Hospital, a 600-bed teaching hospital in Buffalo. The changeover from methicillin-susceptible S. aureus to MRSA begins on the first hospital day, when patients are given cefazolin as presurgical prophylaxis. Under selective antibiotic pressure, colonizing flora change within 24 to 48 hours. For patients remaining hospitalized, subsequent courses of third-generation cephalosporins further select and amplify the colonizing MRSA population. Therefore, managing antibiotic selective pressure might be essential. Other strategies include attention to dosing, so that serum concentrations of drug exceed the minimum inhibitory concentration, and antibiotic cycling. Although there are some promising new antibiotics on the horizon, it is necessary to deal with many resistance patterns by using the combined strategies of infection control and antibiotic management.
authors.affiliation: School of Pharmacy, State University of New York at Buffalo, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Schentag
authors.forename: J M
authors.initials: JM
authors.lastname: Hyatt
authors.forename: J R
authors.initials: JR
authors.lastname: Carr
authors.forename: J A
authors.initials: JA
authors.lastname: Paladino
authors.forename: M C
authors.initials: MC
authors.lastname: Birmingham
authors.forename: G S
authors.initials: GS
authors.lastname: Zimmer
authors.forename: T J
authors.initials: TJ
authors.lastname: Cumbo
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D016984:Enterococcus faecium / Q000187:drug effects*; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control; D008712:Methicillin / Q000494:pharmacology; D016106:Methicillin Resistance; D009518:New York; D010406:Penicillins / Q000494:pharmacology; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects*; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D014640:Vancomycin; D002437:Cefazolin; D008712:Methicillin