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Vancomycin-Resistant Staphylococcus aureus
- Russell N. Olmsted, MPH;
- Paul N. Valenstein, MD; and
- Charles P. Craig, MD
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•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
Some of the measures outlined in the recent article by Edmond and colleagues [1] appear to be misplaced and ignore experience with methicillin-resistant Staphylococcus aureus. Boyce and colleagues [2] extensively reviewed the literature on methicillin-resistant S. aureus and emphasized moderate reaction in the absence of proven benefit or more extreme measures and found no evidence of either airborne or fomite transmission. Their observations should serve as a warning to those who advocate extreme control measures for vancomycin-resistant S. aureus in the absence of any experience with the organism. Sampling of surfaces in the room of the patient infected or colonized with vancomycin-resistant S. aureus after discharge also conflicts with recommendations from the Centers for Disease Control and Prevention. Reliance on mupirocin for topical decolonization without information on antimicrobial susceptibility might also promote additional microbial resistance. In dealing with an outbreak of vancomycin-resistant enterococci, other investigators [3] found that routine surveillance cultures were of little value and that vancomycin-resistant enterococci persisted despite use of contact precautions.
We advocate improved compliance with hand washing and more prudent use of antibiotics. These interventions would also reduce selection and transmission of other antibiotic-resistant microorganisms. Recent strategies [4] advocate an individualized approach for health care facilities. We encourage extension of this approach throughout the health care industry.
The measures suggested by Edmond and colleagues also contain an extensive procedure for processing clinical specimens from patients with vancomycin-resistant S. aureus. These seem to be contrary to those already recommended for clinical microbiology laboratories [5]. We are not aware of data that show the need for additional measures within the laboratory to control spread of S. aureus, and we therefore ask the authors for the rationale behind their recommendation that such facilities be used for vancomycin-resistant S. aureus. Although vancomycin-resistant S. aureus is a legitimate threat, its potential emergence should not lead us to ignore what we have learned about staphylococcal virulence or epidemiology.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
