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Friday, August 18th 2006

The Fourth Member of the Axis of Evil

A study of skin infections presenting to the ER revealed the not just a plurality, but a majority were caused by Methicillin Resistant S. Aureus.

Methicillin isn’t available in the US (odd we still use the term MRSA) but it was the first of a group of beta lactams to be resistant to the first evolutions of beta lactamases.

Penicillin is a beta lactam, it binds to a Penicillin Binding Protein and inhibits the production of bacterial cell walls. From penicillins discovery there have been many more beta lactams developed that work on the same principle. Well, bacteria got clever to it and evolved to produce enzymes which cut up beta lactams.

A group of beta lactams resistant to these beta lactamases appeared starting with methicillin.

So, why is MRSA so bad? Well, the rapid spread of the resistance to methicillin is very alarming. It says something about the future of antibiotics when bacteria evolve resistance so quickly. MRSA first appeared in hospitals, a nosocomial acquired infection that many physicians considered a by product of hospital stays. It has quickly however escaped and become a community acquired condition. This study only further confirms that. As well, S. Aureus can pose a very serious infection and Staph Aureus resistant to methicillin in basically resistant to every beta lactam, which is a huge class of antibiotics.

There are other antibiotics available, obviously. But so many antibiotics, once the hallmark of Staph Aureus treatment, wiped out as viable choices of treatment for what can be a very bad inflection has some a lot of people nervous. How quickly before the bacteria develops resistance mechanisms against the currently viable antibiotic treatments.

Even as we speak, the first line option at many hospitals – Vancomycin – is being found to be ineffective in some S. Aureus cultures as Vancomycin Resistant Enterococci (VRE) transfer the genetic basis for their resistance to S. Aureus (oh yes, some bugs can have sex and transfer genetic material).

MedRants talks about the study and its reccommendation for skin infections (it wants all skin infections to be empirically treated with drugs effective against MRSA).