Why? Because as long as he stays on your skin, you’re fine. But if he gets into your skin, you will be in more and more trouble as time passes. Staph is smart. He hacks into his buddy’s gene pool and uploads resistance. They all swap the resistance files, and pretty soon, they don’t care what antibiotic you throw at them.
Ever hear of MRSA? That’s Methicillin-resistant Staphylococcus aureus. It used to be only in hospitals, but now its everywhere. It’s bothersome, but not necessarily deadly. Now we’ve got VRSA. You don’t hear much about VRSA (Vancomycin-resistant Staphylococcus aureus). That’s because it’s modern medicine’s Achilles heel. Once something is resistant to Vancomycin, it’s time to scramble for something, anything, it might be susceptible to. So far we’ve been lucky, but it’s just a matter of time. Vancomycin was an antibiotic so nasty they retired it, but they’ve brought it out of retirement because we need every weapon we can get.
What happens when Staph becomes resistant to everything in the pharmacy? That’s the end of going to the hospital for an infection. We’ll start seeing a lot more amputations as they desperately try to save limbs. And we’ll see a lot of young, otherwise healthy people succumbing to blood poisoning. We’ve had less than a hundred years of reprieve from the scourge of a cut heading straight into death, but we’ve squandered that time. Even as you read this, the perfect Staph is incubating in some vast livestock megafarm, growing stronger as his host is fed an antibiotic rich slurry that kills everything but him. It’s just a matter of time…
Unless… maybe M.D.s will look up from the labs and out into the world. What resists bacteria? Plants. The plant kingdom is full of antibiotic compounds. We don’t have time to patent them all and give them all testing. Bring them out of the supermarkets and into the hospital rooms. Maybe in the future your doctor will hand you a handful of ginger, or ground rinds from a plant, or one of the thousands of antibiotic compounds contained in the herbal kingdom. We need to understand that the petty turf warfare between branches of medicine must end. M.D.s must embrace their alternative brethren and work together to make the world well.
Clin Microbiol Infect. 2006 Apr;12 Suppl 2:3-10.
MRSA–the tip of the iceberg.
Methicillin-resistant Staphylococcus aureus (MRSA) strains cause serious nosocomial infections all over the world. Overall, approximately 20% of S. aureus isolates in Europe are reported as methicillin-resistant, whereas in US hospitals the prevalence ranges from 33% to 55%. The past few years have also witnessed an increase in life-threatening community-acquired infections caused by Panton-Valentine leukocidin-producing MRSA in the USA. Increasing use of glycopeptides for treatment of community-acquired MRSA infections may result in higher rates of glycopeptide resistance. Since 1996, five vancomycin-intermediate S. aureus (VISA; vancomycin MIC = 8-16 mg/L) strains have been identified in Europe, Asia and the USA, and vancomycin-resistant S. aureus (VRSA) strains (vancomycin MIC > or = 32 mg/L) have also been reported in the USA between 2002 and 2005. Most infections with VISA and VRSA have occurred in a setting of heavy prior use of glycopeptides and other antimicrobial agents. Emergence of reduced vancomycin susceptibility in S. aureus increases the possibility that currently available antimicrobial agents may become ineffective for treating systemic infections, especially bacteraemia, endocarditis and osteomyelitis. Ceftobiprole is a novel broad-spectrum cephalosporin with expanded activity against Gram-positive bacteria, including MRSA. Ceftobiprole is refractory to the development of endogenous resistance both in vitro and in vivo. The additional activity of ceftobiprole against MRSA strains makes it a potentially important addition to currently available agents.
J Microbiol Immunol Infect. 2011 Apr;44(2):131-8. Epub 2011 Jan 14.
Changing trends in antimicrobial resistance of major bacterial pathogens, 1985-2005: a study from a medical center in northern Taiwan.
Lo WT, Lin WJ, Chiueh TS, Lee SY, Wang CC, Lu JJ.
Antimicrobial resistance is a major health problem worldwide. We evaluated the antimicrobial resistance trends of 16 major bacterial pathogens at a tertiary medical center in northern Taiwan.
We conducted a retrospective review of annual summary documents for antimicrobial susceptibility of clinically isolated gram-positive and gram-negative bacteria from 1985 to 2005. The numbers of isolates and susceptibilities were calculated for three 7-year periods: first period, 1985-1991; second period, 1992-1998; and the third period, 1999-2005.
During the 21-year period, 219,715 bacterial pathogens were identified. A significant increase in incidence over time was found for methicillin-resistant Staphylococcus aureus, methicillin-resistant S epidermidis, penicillin-nonsusceptible Streptococcus pneumoniae, erythromycin-resistant S pneumoniae, vancomycin-resistant enterococci, cefotaxime/ceftriaxone-resistant Escherichia coli and Klebsiella pneumoniae, and imipenem-resistant Acinetobacter baumannii. Additionally, a significant increase in ciprofloxacin resistance rates over time from 1996 to 2005 was noted for E coli, Enterobacter cloacae, and A baumannii (through 1997 to 2005). However, a significant decrease in erythromycin resistance rate with time from 1999 to 2005 was found for Groups A and B streptococci, non-A, B, D streptococci, and S pneumoniae.
Resistance to antimicrobial agents increased rapidly in the past two decades in Taiwan and has become very common in major bacterial pathogens. Continuous enforcement of policies to limit use of antimicrobial agents and active surveillance of antimicrobial resistance through a nationwide system are both warranted.
Copyright © 2011. Published by Elsevier B.V.
Indian J Med Res. 2011 Nov;134(5):704-8
Vancomycin resistance among methicillin resistant Staphylococcus aureus isolates from intensive care units of tertiary care hospitals in Hyderabad.
Thati V, Shivannavar CT, Gaddad SM.
Department of P.G. Studies & Research in Microbiology, Gulbarga University, Gulbarga, India.
BACKGROUND & OBJECTIVES:
Multidrug resistant methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial and community acquired infections and is on the rise. The glycopeptide vancomycin has been proposed as the drug of choice for treating such infections. The present study aimed at identifying the vancomycin resistance both phenotypically and genotypically among the MRSA isolates from two tertiary care hospitals in Hyderabad, south India.
MRSA were isolated and identified from different clinical samples collected from ICUs of tertiary care hospitals in Hyderabad using conventional methods. Antibiogram of the isolates and vancomycin MIC were determined following CLSI guidelines. vanA was amplified by PCR using standard primers.
All vancomycin resistant S. aureus (VRSA) isolates were MRSA. The VRSA isolates were positive for vanA gene, except one which was negative. All VRSA had a vancomycin MIC in the range of 16-64 mg/l.
INTERPRETATION & CONCLUSIONS:
The increase in vancomycin resistance among MRSA and excessive use of antimicrobial agents have worsened the sensitivity. Larger studies need to be done in various geographical regions of the country to better define the epidemiology, mechanism of vancomycin resistance in S. aureus and its clinical implications.
Bioinformation. 2011;7(5):222-33. Epub 2011 Oct 31.
Computer aided screening and evaluation of herbal therapeutics against MRSA infections.
Skariyachan S, Krishnan RS, Siddapa SB, Salian C, Bora P, Sebastian D.
Methicillin resistant Staphylococcus aureus (MRSA), a pathogenic bacterium that causes life threatening outbreaks such as community-onset and nosocomial infections has emerged as ‘superbug’. The organism developed resistance to all classes of antibiotics including the best known Vancomycin (VRSA). Hence, there is a need to develop new therapeutic agents. This study mainly evaluates the potential use of botanicals against MRSA infections. Computer aided design is an initial platform to screen novel inhibitors and the data finds applications in drug development. The drug-likeness and efficiency of various herbal compounds were screened by ADMET and docking studies. The virulent factor of most of the MRSA associated infections are Penicillin Binding Protein 2A (PBP2A) and Panton-Valentine Leukocidin (PVL). Hence, native structures of these proteins (PDB: 1VQQ and 1T5R) were used as the drug targets. The docking studies revealed that the active component of Aloe vera, β-sitosterol (3S, 8S, 9S, 10R, 13R, 14S, 17R) -17- [(2R, 5R)-5-ethyl-6-methylheptan-2-yl] -10, 13-dimethyl 2, 3, 4, 7, 8, 9, 11, 12, 14, 15, 16, 17- dodecahydro-1H-cyclopenta [a] phenanthren-3-ol) showed best binding energies of -7.40 kcal/mol and -6.34 kcal/mol for PBP2A and PVL toxin, respectively. Similarly, Meliantriol (1S-1-[ (2R, 3R, 5R)-5-hydroxy-3-[(3S, 5R, 9R, 10R, 13S, 14S, 17S)-3-hydroxy 4, 4, 10, 13, 14-pentamethyl-2, 3, 5, 6, 9, 11, 12, 15, 16, 17-decahydro-1H-cyclopenta[a] phenanthren-17-yl] oxolan-2-yl] -2- methylpropane-1, 2 diol), active compound in Azadirachta indica (Neem) showed the binding energies of -6.02 kcal/mol for PBP2A and -8.94 for PVL toxin. Similar studies were conducted with selected herbal compound based on pharmacokinetic properties. All in silico data tested in vitro concluded that herbal extracts of Aloe-vera, Neem, Guava (Psidium guajava), Pomegranate (Punica granatum) and tea (Camellia sinensis) can be used as therapeutics against MRSA infections.
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