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Delaware Health Alert Network #222

April 14, 2010 5:28 pm


Health Alert
VANCOMYCIN RESISTANT STAPHYLOCOCCUS AUREUS (VRSA) CASE CONFIRMED IN DELAWARE


Background

Delaware Division of Public Health (DPH) reports a confirmed case of vancomycin resistant Staphylococcus aureus (VRSA). The 63 year old patient with multiple co-morbidities was recently hospitalized in Delaware and was a short term resident of a Delaware long term care facility in addition to receiving outpatient hemodialysis. On April 6, lab tests by the Centers for Disease Control and Prevention (CDC) convirmed VRSA. The patient was later transferred to a Pennsylvania hospital.

The VRSA isolated by the DPH Laboratory and CDC is susceptible to daptomycin, linezolid, tigecycline, doxycycline, tetracycline and bactrium.

Staphylococcus aureus is an important cause of healthcare and community-associated infections. Diseases associated with this common pathogen range from mild skin and soft tissue infections to potentially fatal systemic infections and affects individuals of all ages. Previously uniformly susceptible to penicillin, widespread use of this antibiotic led to increased resistance and resultant reliance on vancomycin for treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. The increased use of vancomycin has resulted in a change of the susceptibility of Staphylococcus aureus to this antibiotic.

The possibility of VRSA should be considered in patients who present with skin infections, bloodstream infections, surgical wound infections, and have history of underlying chronic conditions (such as chronic skin ulcers and diabetes), previous treatment with vancomycin, and history of MRSA or vancomycin resistant enterococcus (VRE).

VRSA infections are rare in the United States (U.S.). This Delaware case represents only the 11th confirmed case of VRSA reported in the U.S. DPH Bureau of Epidemiology is investigating this case and possible contacts per CDC recommendation.

Transmission of VRSA

VRSA is potentially transmissible from person-to-person, but such transmission has not been documented. To date, all patients with confirmed VRSA infections have had significant co-morbidities such as diabetes and renal disease, previous infections with MRSA, invasive procedures and devices, recent hospitalizations and recent exposure to vancomycin and other antimicrobial agents.

Prevention and Control

Infection control guidelines and practices in healthcare facilities are well documented and include the prevention and control of multidrug-resistant organisms (MDRO), including VRSA. Stringent handwashing, the use of barrier and contact precautions and appropriate antibiotic use are the basis for controlling the spread of any infectious disease.

For detailed CDC guidelines for the control of VRSA please reference:

http://www.cdc.gov/ncidod/dhqp/pdf/ar/visa_vrsa_guide.pdf

For More Information

For more information on VRSA, please visit the CDC website at: http://www.cdc.gov/ncidod/dhqp/ar_visavrsa.html.

DPH, Bureau of Epidemiology can be contacted at (302) 744-1033 or 1-888-295-5156.

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