The misuse of vancomycin.

Abstract

1. Catherine C. Skae, MD 1. Children’s Hospital at Montefiore, Bronx, NY 1. Staphylococcus aureus Resistant to Vancomycin—United States, 2002. MMWR Morb Mortal Wkly Rep. 2002;51:565–567 2. Vancomycin Resistance in the Enterococcus. Relevance in Pediatrics. Rice LB, Shlaes DM. Pediatr Clin North Am. 1995;42:601–618 3. Reducing the Spread of Antimicrobial Resistant Microorganisms. Control of Vancomycin-resistant Enterococci. Shay DK, Goldman DA, Jarvis WR. Pediatr Clin North Am. 1995;42:703–716 The first cases of vancomycin-resistant enterococci (VRE) were reported in the late 1980s. Prior to that, clinicians took comfort in the virtually universal activity of vancomycin against enterococci and staphylococci. Enterococci are gram-positive, catalase-negative, facultative anaerobic bacteria that are a major component of the normal gastrointestinal microflora. At least 12 species of enterococci have been described, although most clinical infections are caused by two species: E faecalis (85% to 90%) and E faecium (5% to 10%). These nosocomial pathogens are intrinsically resistant to a variety of commonly used antibiotics. In addition, enterococci have the impressive ability to acquire resistant determinants to most antimicrobial agents. Microorganisms that are resistant to multiple antibiotics pose a public health threat and, thus, are of utmost concern to clinicians, microbiologists, and epidemiologists. In pediatric patients, the most resistant organisms typically are found in tertiary care hospitals where children who have severe underlying diseases are hospitalized for prolonged periods of time. Immunosuppression, invasive diagnostic and therapeutic devices, aggressive surgery (including organ transplantation), and intensive therapy with broad-spectrum …