ATLANTA — Because the occurrence of fully
vancomycin-resistant staphylococcal infections in a hospital
could result in serious public health consequences, interim
guidelines were recently developed to direct the response when
staphylococci with reduced vancomycin susceptibility are
identified.
Developed by the Centers for Disease Control and Prevention
(CDC) and the Hospital Infection Control Practices Advisory
Committee (HICPAC), the guidelines provide information for
detecting the strain as well as preventing transmission.
The susceptibility pattern of a particular staphylococcal
strain, the site of infection and the response to conventional
therapy are important in determining the need for
investigational antimicrobials to treat infections caused by
staphylococci with reduced vancomycin susceptibility. The
usefulness of any antimicrobial agent will depend on the
resistance mechanism and susceptibility pattern of the S.
aureus strain. Physicians treating infections caused by
staphylococci with reduced vancomycin susceptibility can
obtain information about investigational drugs from the FDA’s
Division of Anti-Infective Drug Products at 301-827-2120.
Use of recommended laboratory methods for identifying these
strains is essential. The following steps should be taken
whenever an organism is isolated:
- The most accurate form of antimicrobial susceptibility
testing for staphylococci is a minimal inhibitory
concentration (MIC) method using a full 24-hour incubation.
- All strains with MIC at or less than 4 mg/mL should be
considered candidate strains for reduced vancomycin
susceptibility.
- After repeat testing, if species identification and
vancomycin test results are consistent, immediately contact
the state health department and the CDC’s Hospital
Infections Program, National Center for Infectious Diseases
at 404-639-6400.
- Retest staphylococci isolated from patients who fail to
respond to vancomycin therapy because resistance may have
emerged during therapy.
To prevent the spread of staphylococci with reduced
susceptibility to vancomycin within and among facilities and
to minimize the potential for the organism to become endemic,
the following steps should be taken whenever such an organism
is isolated:
- The laboratory should immediately notify infection
control personnel, the clinical unit and the attending
physician.
- Infection control staff with appropriate authorities
should initiate an epidemiologic and laboratory
investigation.
- Medical and nursing staff should: isolate the patient and
use contact precautions as recommended for
multidrug-resistant organisms; minimize the number of people
with access to colonized/infected patients; and dedicate
specific healthcare workers to provide one-on-one care for
the colonized/infected patient.
- Infection control staff should: inform all personnel
providing direct patient care of the epidemiologic
implications of such strains and of the infection control
precaution needed for their containment; monitor and
strictly enforce compliance with infection control
practices; determine whether transmission has already
occurred by obtaining baseline cultures from the anterior
nares and hands of all healthcare workers, roommates and
others with direct patient contact; assess efficacy of
precautions by monitoring healthcare personnel for
acquisition of the resistant staphylococci as recommended by
consultants from the state health department and the CDC;
avoid transferring infected patents within or among
facilities and if transfer is necessary, fully inform the
receiving institution or unit of the patient’s
colonization/infection status and appropriate precautions;
and consult with the state health department and the CDC
before discharging the patient.
For more information:
- CDC. Interim guidelines for prevention and
control of Staphylococcal infection associated with
reduced susceptibility to vancomycin. MMWR.1997;27:626-635.
![[bar]](/art/gradred.gif){kind=small}
You
can express your views on this article, or other relevant
themes, in the Infectious
Diseases in Children Specialty Forums.