Vancomycin-Resistant Enterococci and Vancomycin-Resistant Staphylococcus aureus: Heralding the end of the antibiotic era?

Abstract

The emergence of organisms resistant to commonly utilized antimicrobial agents has reached global epidemic proportions. In particular, nosocomial pathogens with antimicrobial resistant phenotypes, are presenting significant clinical difficulties. These difficulties arise due to limited efficacious antimicrobial agents available to treat patients infected with these organisms. Two organisms which currently represent major nosocomial pathogens include enterococci and Staphylococcus aureus. Both organisms exhibit antimicrobial resistant phenotypes which currently make clinical management difficult. Vancomycin-resistant enterococci (VRE) is endemic in many major US hospitals and outbreaks of this organism have been documented in Canada. More recently, isolates of vancomycin-resistant Staphylococcus aureus (VRSA) have been identified in Japan and the US. Vancomycin is often the last line antimicrobial available for treatment of infections caused by these organisms which have acquired resistance to virtually all other antimicrobials used. Therefore, infection control policies must be strengthened to contain the spread of these organisms. As well, these infection control policies must be utilized in conjunction with specific guidelines concerning antimicrobial usage to prevent the selection of new resistant organisms.