RESISTANT STAPHYLOCOCCUS AUREUS TREATMENT Staphylococcus aureus is one of the most dangerous pathogen microorganisms, which causes serious hospital-acquired and community-associated infections. The uniqueness of Staphylococcus aureus bacterium is the fact that it has developed resistance to all beta-lactam antibiotics for many decades. The pharmacological group of beta-lactam antibiotics includes five major classes of antibacterial drugs, such as: Monobactams (Aztreonam) Carbacephems (Loracarbef) Penems (Imipenem, Meropenem, Faropenem) Cephalosporins of the first, second and third generation (Cephalexin, Cefadroxil, Cephapirin, Cefuroxime, Cefaclor, Cefuroxime, Cefamandole, Cefmetazole, Cefdinir, Ceftazidime, Cefixime, Ceftizoxime, Moxalactam). Penicillins (Amoxicillin, Ampicillin, Azlocillin, Carbenicillin, Cloxacillin, Dicloxacillin, Mezlocillin, Nafcillin, Oxacillin, Piperacillin, Ticarcillin). Multidrug resistant to staphylococcus aureus significantly complicates the treatment of infectious diseases. The complexity of antibiotic therapy is not only in the fact that staphylococcus aureus has developed resistance to different classes of antibiotics. Resistant staphylococcal infection is able to travel into the blood and infect several vital organs. Therefore, diseases caused by this infection can progress rapidly and cause life-threatening conditions, such as toxic shock syndrome, sepsis and pneumonia. Resistant staphylococcus aureus symptoms are similar to the symptoms of other types of bacterial infections. Therefore, it is impossible to diagnose antibiotic resistant form of staphylococcus aureus only by means of physical examination. It should be noted that a few decades ago, resistant form of staphylococcus aureus infection was observed only in patients of clinics. However, during evolution, this staph infection was transformed into community-associated form. Therefore, it is becoming increasingly difficult to control the spread of antibiotic-resistant staphylococcus aureus year by year. Just many other types of bacteria, resistant staphylococcus aureus causes infectious disease only under certain conditions. The diseases caused by resistant S. aureus form are most often diagnosed in immunocompromised people.
Immunosuppression and subsequent development of antibiotic-resistant staphylococcus aureus infection can occur because of chronic diseases (such as, skin), injection therapy with psychotropic drugs, pregnancy, or because of injuries. One of the last known cases of dangerous staph infection because of injury occurred in the USA, at the end of 2015. One of the players of professional American football team New York Giants – Daniel Fells was hospitalized with the symptoms of resistant staphylococcus aureus, which developed while being treated for an ankle injury. Daniel Fells was diagnosed with the most common form of multidrug resistant infection – Methicillinresistant staphylococcus aureus (MRSA). Within two weeks after the confirmation of MRSA diagnosis, Daniel Fells underwent six operations and a long course of antibiotic therapy. Thanks to timely treatment of Methicillin-resistant staphylococcus aureus, Daniel Fells managed to prevent the development of dangerous complications. However, because of the operations he underwent, Daniel Fells unlikely will be able to play football again. MRSA is the most common term used when describing resistant staphylococcus aureus. Less common, the term ORSA (Oxacillin-resistant staphylococcus aureus) is used in medical journals. These terms have identical definitions. It is noteworthy that the definitions for MRSA and ORSA are incomplete in the Wikipedia. The Free Encyclopedia states that these types of infections are resistant to cephalosporins and penicillins. However, there is no information in the Wiki that staphylococcus aureus bacterium can be resistant to the antibacterial effect of penems, monobactams and carbacephems. Therefore, Wikipedia and other unreliable sources of information should not be used for self-treatment of dangerous infectious diseases. Be sure to inform a health care professional about the occurrence of any signs and symptoms of bacterial infections (including cases of staphylococcus aureus relapse). Timely medical assistance and adequate antibiotic therapy can help to stop the development of multidrug resistant staphylococcus aureus (MRSA / ORSA) and quickly to cure this potentially dangerous bacterial infection. This chapter reviews data on the treatment of infections caused by drug-resistant Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA). This review covers findings reported in the English language medical literature up to January of 2013. Despite the emergence of resistant and multidrug-resistant S. aureus, we have seven effective drugs in clinical use for which little resistance has been observed: vancomycin, quinupristin-dalfopristin, linezolid, tigecycline, telavancin, ceftaroline, and daptomycin. However, vancomycin is less effective for infections with MRSA isolates that have a higher MIC within the susceptible range. Linezolid is probably the drug of choice for the treatment of complicated MRSA skin and soft tissue infections (SSTIs); whether it is drug of choice in pneumonia remains debatable. Daptomycin has shown to be non-inferior to either vancomycin or β-lactams in the treatment of staphylococcal SSTIs, bacteremia, and right-sided endocarditis. Tigecycline was also non-
inferior to comparator drugs in the treatment of SSTIs, but there is controversy about whether it is less effective than other therapeutic options in the treatment of more serious infections. Telavancin has been shown to be non-inferior to vancomycin in the treatment of SSTIs and pneumonia, but has greater nephrotoxicity. Ceftaroline is a broad-spectrum cephalosporin with activity against MRSA; it is noninferior to vancomycin in the treatment of SSTIs. Clindamycin, trimethoprim-sulfamethoxazole, doxycycline, rifampin, moxifloxacin, and minocycline are oral anti-staphylococcal agents that may have utility in the treatment of SSTIs and osteomyelitis, but the clinical data for their efficacy is limited. There are also several drugs with broad-spectrum activity against Gm-positive organisms that have reached the phase II and III stages of clinical testing that will hopefully be approved for clinical use in the upcoming years: oritavancin, dalbavancin, omadacycline, tedizolid, delafloxacin, and JNJ-Q2. Thus, there are currently many effective drugs to treat resistant S. aureus infections and many promising agents in the pipeline. Nevertheless, S. aureus remains a formidable adversary, and despite our deep bullpen of potential therapies, there are still frequent treatment failures and unfortunate clinical outcomes. The following discussion summarizes the clinical challenges presented by MRSA, the clinical experience with our current anti-MRSA antibiotics, and the gaps in our knowledge on how to use these agents to most effectively combat MRSA infections. For more information visit us our website: http://www.healthinfi.com