Gram positive infection in trauma patients: New strategies to decrease emerging Gram-positive resistance and vancomycin toxicity

Enrique Ginzburg, Nicholas Namias, Margaret Brown, Suzette Ball, Syed M. Hameed, Stephen M. Cohn

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Bacterial resistance to antibiotics has become a serious problem in medicine. Particularly worrisome is the increasing incidence of multi-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Not surprisingly, in view of the high incidence of life-threatening infections and heavy antibiotic use, resistance has become very frequent and problematic in intensive care units. The standard approach for the treatment of MRSA is vancomycin or teicoplanin. Long-term therapeutic and unrestricted prophylactic use of vancomycin has given rise to VRE which in turn may lead to the emergence of vancomycin-resistant S. aureus (VRSA) through plasmid mediated transmission. In order to reduce the incidence of VRE and to avoid the emergence of VRSA, vancomycin use should be restricted and alternative antibiotic strategies should be developed. Using those antibiotics to which MRSA are still generally sensitive, perhaps in combination with new ones, such as, quinupristin/dalfopristin, should be entertained. We performed a retrospective review of the Gram-positive infections in our Level 1 Trauma Center Intensive Care Unit, and an analysis of the resistance patterns of the NMSA infections showed that additional resistance rarely develops within less than 5 days. We then designed a new strategy for the treatment of MRSA infections. This strategy consists of the sequential use of a range of antibiotics with activity against MRSA in short 5-7 day pulses until the full clinical course is completed. Studies validating the benefit of this approach are currently in preparation.

Original languageEnglish
JournalInternational Journal of Antimicrobial Agents
Volume16
Issue numberSUPPL. 1
StatePublished - Dec 1 2000

Fingerprint

Vancomycin Resistance
Vancomycin
Methicillin-Resistant Staphylococcus aureus
Wounds and Injuries
Infection
Anti-Bacterial Agents
Intensive Care Units
Staphylococcus aureus
Incidence
Bacterial Drug Resistance
Teicoplanin
Trauma Centers
Microbial Drug Resistance
Plasmids
Therapeutics
Medicine
Vancomycin-Resistant Enterococci

Keywords

  • Gram-positive
  • Staphylococcus aureus
  • Trauma patients

ASJC Scopus subject areas

  • Applied Microbiology and Biotechnology
  • Microbiology
  • Parasitology
  • Virology
  • Immunology and Allergy
  • Infectious Diseases

Cite this

Gram positive infection in trauma patients : New strategies to decrease emerging Gram-positive resistance and vancomycin toxicity. / Ginzburg, Enrique; Namias, Nicholas; Brown, Margaret; Ball, Suzette; Hameed, Syed M.; Cohn, Stephen M.

In: International Journal of Antimicrobial Agents, Vol. 16, No. SUPPL. 1, 01.12.2000.

Research output: Contribution to journalArticle

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