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Vancomycin Intermittently Resistant Staphylococcus Aureus:- Causes, Symptoms and Treatments

Vancomycin intermittently resistant Staphylococcus aureus (VIRSA) is a mutation of a bacterium that is spread easily by direct person-to-person contact. It was first discovered in mid-1996 when clinicians found the microbe in a Japanese infant's surgical wound. Similar isolates were reported in Michigan and New Jersey. Both patients had received multiple courses of vancomycin for methicillin­resistant Staphylococcus aureus (MRSA) infections.

Another mutation, vancomycin-resistant Staphylococcus aureus (VRSA) is fully resistant to vancomycin. Patients most at risk for infection by resistant microbes include:

. patients with a history of taking vancomycin, third-generation cephalosporins, or antibiotics targeted at anaerobic bacteria (such as Clostridium difficile)

. patients with indwelling urinary or central venous catheters

. elderly patients, especially those with prolonged or repeated hospital admissions

. patients with malignancies or chronic renal failure

. patients undergoing cardiothoracic or intra-abdominal surgery or organ transplants

. patients with wounds with an opening to the pelvic or intra-abdominal area, including surgical wounds, burns, and pressure ulcers

. patients with enterococcal bacteremia, often associated with endocarditis

. patients exposed to contaminated equipment or to a patient with the infecting microbe.

Causes of Vancomycin Intermittently Resistant Staphylococcus Aureus:

MRSA enters health care facilities through an infected or colonized patient or a colonized health care worker. It is thought that VIRSA/VRSA is colonized in a similar method. It is spread through direct contact between the patient and caregiver or between patients. It may also be spread through patient contact with contaminated surfaces such as an overbed table. It is capable of living for weeks on surfaces. It has been detected on patient gowns, bed linens, and handrails.

Signs and symptoms of Vancomycin Intermittently Resistant Staphylococcus Aureus:

There are no specific signs or symptoms related to infection by this microbe. The causative agent may be found incidentally when culture results show the microbe.

Diagnosis of Vancomycin Intermittently Resistant Staphylococcus Aureus:

Someone with no signs or symptoms of infection is considered colonized if VIRSA or VRSA can be isolated from stool or a rectal swab. A patient who is colonized is more than 10 times as likely to become infected with the organism (for example, through a breach in the immune system) than a patient who is not.

Treatment of Vancomycin Intermittently Resistant Staphylococcus Aureus:

There is virtually no antibiotic to combat VIRSA or VRSA. Recently, the Centers for Disease Control and Prevention and the Hospital Infection Control Practices Advisory Committee proposed a two-level system of precautions to simplify isolation for resistant organisms. The first level calls for standard precautions, which incorporate features of universal blood and body fluid precautions, and body substance isolation precautions, to be used for all patient care. The second level calls for transmission-based precautions, implemented when a particular infection is suspected.

To prevent the spread of VIRSA and VRSA, some hospitals perform weekly surveillance cultures on at-risk patients in intensive care units or oncology units, and on patients who have been transferred from a long-term care facility. Any colonized patient is then placed in contact isolation until he's culture-negative or discharged. Colonization can last indefinitely, and no protocol has been established for the length of time a patient should remain in isolation.

Because no single antibiotic is currently available, the doctor may opt not to treat an infection at all. Instead, he may stop all antibiotics and simply wait for normal bacteria to repopulate and replace the strain. Combinations of various drugs may also be used, depending on the source of the infection.

Special considerations of Vancomycin Intermittently Resistant Staphylococcus Aureus:

1. Personnel in contact with an infected patient should wash their hands before and after care of the patient.

2. Good hand washing is the most effective way to prevent VIRSA and VRSA from spreading.

3. Use an antiseptic soap such as chlorhexidine; bacteria have been cultured from workers' hands after they've washed with milder soap.

4. Maintain contact isolation precautions when in contact with the patient. Provide a private room and dedicated equipment, and disinfect the environment.

5. Change gloves when contaminated or when moving from a dirty area of the body to a clean one.

6. Do not touch potentially contaminated surfaces, such as a bed or bed stand, after removing gown and gloves.

7. Be particularly prudent in caring for a patient with an ileostomy, colostomy, or draining wound that is not contained by a dressing.

8. Instruct family and friends to wear protective garb when they visit the patient, and teach them how to dispose of it.

9. Provide teaching and emotional support to the patient and family members.

10. Consider grouping infected patients together (known as cohorting) and having the same nursing staff care for them.

11. Do not lay equipment used on the patient on the bed or bed stand; wipe it with appropriate disinfectant before leaving the room.

12. Ensure judicious and careful use of antibiotics. Encourage doctors to limit the use of antibiotics.

13. Instruct patients to take antibiotics for the full prescription period, even if they begin to feel better.

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