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Second 'Superbug' Staph Infection Appears

New case of resistance to potent antibiotic

THURSDAY, Oct. 10, 2002 (HealthDayNews) -- Three months after the first case of "superbug" staphylococcus appeared in the United States, a second person has been diagnosed with the drug-resistant infection, health officials say.

Disease detectives in Pennsylvania say they identified a patient with vancomycin-resistant Staphylococcus aureus, or VRSA, last month. Vancomycin is one of the most powerful drugs to treat staph aureus infections, which are picked up by more than 200,000 hospital patients a year in this country alone.

S. aureus had already gained resistance to the earlier front-line therapy against it, methicillin, leaving vancomycin as the drug to kill it without fail. However, in recent years hardier strains of staph have cropped up in Europe, Japan and the United States that can withstand vancomycin to some degree before succumbing.

In another ominous sign, in 1988 scientists saw the emergency of vancomycin-resistant enterococcus, another bacterium. That event suggested it was only a matter of time before VRSA emerged -- and it did.

The new case is the second recorded incidence of VRSA in this country, following the discovery in June of a 40-year-old kidney failure patient in Michigan who also developed the infection. In both cases, the germ proved sensitive to other antibiotics.

Dr. Andre Weltman, of the Pennsylvania Department of Health, declined discussing details of the case, which officials are still investigating. However, Weltman says the patient, who was not identified, had been "in and out" of hospitals for several years and had also taken vancomycin in the past.

"What's of concern, but what's unanswered right now, is was this created clearly as a result of vancomycin exposure" or was the resistant bug a genetic cross between vancomycin-resistant enterococcus and methicillin-resistant staph.

"That's very likely what happened," says Dr. Scott Fridkin, a Centers for Disease Control and Prevention medical epidemiologist working on the case. If so, it would mark only the second time such a mixed strain of S. aureus has been discovered worldwide, the other incident being the patient in Michigan, Fridkin says.

Staph infections can spread from person to person or by contact with fomites. These are inanimate objects, like a catheter or blood pressure cuff, contaminated with the germs. "We're looking to find out where this has spread," Weltman says. "We're optimistic it hasn't."

Methicillin-resistant staph infections (MRSA) now occur in as many as 80,000 hospital patients in this country each year, so VRSA is still only a budding problem. But it could spiral out of control without more careful prescribing from doctors and better hand washing by everyone, Fridkin says.

"Our hope is that through a concerted public health response to the emergence of VRSA, not only will we prevent continued emergence but we will reduce both [vancomycin-resistant enterococcus] and MRSA in the United States and worldwide," Fridkin says.

The Netherlands, Denmark and Belgium have been "very impressive success stories" in their efforts to reverse MRSA, he adds. "The battle is not lost."

What To Do

For more on S. aureus, try the U.S. Food and Drug Administration or the Centers for Disease Control and Prevention.

SOURCES: Andre Weltman, M.D., public health physician, Pennsylvania Department of Health, Harrisburg; Scott Fridkin, M.D., medical epidemiologist, Centers for Disease Control and Prevention, Atlanta; Oct. 11, 2002, Morbidity and Mortality Weekly Report
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