WHO Scientific Working Group on monitoring and management of bacterial resistance to antimicrobial agents.
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Anti-Bacterial Agents↗
Biomedical subjects
F C Tenover
Publications and source records attributed to F C Tenover.
Vancomycin-resistant enterococci outside the health-care setting: prevalence, sources, and public health implications.
Although nosocomial acquisition and subsequent colonization of vancomycin-resistant enterococci (VRE), an emerging international threat to public health, has been emphasized in the United States, colonization among nonhospitalized persons has been infrequently documented. In contrast, in Europe, colonization appears to occur frequently in persons outside the health-care setting. An important factor associated with VRE in the community in Europe has been avoparcin, a glycopeptide antimicrobial drug used for years in many European nations at subtherapeutic doses as a growth promoter in food-producing animals. In Europe, evidence suggests that foodborne VRE may cause human colonization. Although avoparcin has never been approved for use in the United States, undetected community VRE transmission may be occurring at low levels. Further studies of community transmission of VRE in the United States are urgently needed. If transmission with VRE from unrecognized community sources can be identified and controlled, increased incidence of colonization and infection among hospitalized patients may be prevented.
Animal Feed↗
Staphylococcus aureus with reduced susceptibility to vancomycin isolated from a patient with fatal bacteremia.
A Staphylococcus aureus isolate with reduced susceptibility to vancomycin was obtained from a dialysis patient with a fatal case of bacteremia. Comparison of the isolate with two methicillin-resistant S. aureus (MRSA) isolated obtained from the same patient 4 months earlier suggests that the S. aureus with reduced susceptibility to vancomycin emerged from the MRSA strain with which the patient was infected. Atypical phenotypic characteristics, including weak or negative latex-agglutination test results, weak or negative-slide coagulase test results, heterogeneous morphologic features, slow rate of growth, and vancomycin susceptibility (by disk diffusion test) were observed.
Aged↗
Lack of evidence for chloramphenicol resistance in Neisseria meningitidis, Africa.
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Anti-Bacterial Agents↗
Increasing resistance to vancomycin and other glycopeptides in Staphylococcus aureus.
Strains of Staphylococcus aureus with reduced susceptibility to glycopeptides have been reported from Japan, the United States, Europe, and the Far East. Although isolates with homogeneous resistance to vancomycin (MICs = 8 microg/mL) continue to be rare, there are increasing reports of strains showing heteroresistance, often with vancomycin MICs in the 1-4 microg/mL range. Most isolates with reduced susceptibility to vancomycin appear to have developed from preexisting methicillin-resistant S. aureus infections. Many of the isolates with reduced susceptibility to glycopeptides have been associated with therapeutic failures with vancomycin. Although nosocomial spread of the vancomycin-intermediate S. aureus (VISA) strains has not been observed in U.S. hospitals, spread of VISA strains has apparently occurred in Japan. Broth microdilution tests held a full 24 hours are optimal for detecting resistance in the laboratory; however, methods for detecting heteroresistant strains are still in flux. Disk-diffusion tests, including the Stokes method, do not detect VISA strains. The Centers for Disease Control and Prevention and other groups have issued recommendations regarding appropriate infection control procedures for patients infected with these strains.
Anti-Bacterial Agents↗
Vancomycin-intermediate Staphylococcus aureus in a home health-care patient.
In June 2000, vancomycin-intermediate Staphylococcus aureus (VISA) was isolated from a 27-year-old home health-care patient following a complicated cholecystectomy. Two VISA strains were identified with identical MICs to all antimicrobials tested except oxacillin and with closely related pulsed-field gel electrophoresis types. The patient was treated successfully with antimicrobial therapy, biliary drainage, and reconstruction. Standard precautions in the home health setting appear successful in preventing transmission.
Adult↗
The challenges of emerging infectious diseases. Development and spread of multiply-resistant bacterial pathogens.
Resistance is an emerging problem in human medicine and the effects of resistance are being noted on an ever-increasing scale. Whether it is treatment of nosocomial bacteremia in New York City or community-acquired dysentery in Central Africa, multiresistant organisms are diminishing our ability to control the spread of infectious diseases. Clearly, the rate at which resistant organisms develop is not solely a function of the use of antimicrobials in humans, but is also highly influenced by the use of these agents in veterinary medicine, animal husbandry, agriculture, and aquaculture, as has been emphasized at recent meetings sponsored by organizations such as Rockefeller University and the American Society for Microbiology, and in the report on bacterial resistance recently issued by the US Office of Technology Assessment. We have entered an era where both physicians and patients must take on the responsibility to use antimicrobials wisely and judiciously. Just as in the days at the turn of the century when the public was an integral part of establishing quarantines for infectious diseases, now again the public's cooperation must be sought for this latest threat to public health. The multiresistant organisms of the 1990s are a grim warning of the possibility of the postantibiotic era.
Bacteria↗
Emerging problems in antimicrobial resistance.
The ability of many different species of bacteria to resist the inhibitory action of antimicrobial agents has become a global problem. As the magnitude of the problem continues to increase, it is imperative that healthcare professionals, particularly nurses who administer antimicrobial agents on a daily basis, become familiar with the causes of antibiotic resistance and the ways in which the emergence of resistance can be prevented or minimized. It also is important that the proper use of antimicrobial agents and the problems associated with misuse be conveyed to patients receiving intravenous therapy, particularly those receiving therapy outside of traditional healthcare settings. This article will highlight some of the factors leading to the development of resistance in bacteria and the problems facing the medical community and the public regarding the spread of resistant bacteria in hospital and community settings.
Cross Infection↗