1. Vancomycin Resistance Staphylococcus Aureus –
A Microscopic and International Crisis
Michael C. Rangel
The Community College of Philadelphia
Microbiology 241
Dr. Dominic Salerno
June 22nd, 2015

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VRSA- A Microscopicand International Crisis
It should come to no surprise that antibiotics, especially Vancomycin is frequently and
inappropriately prescribed. In one study, medical records of adult patients who had been
prescribed vancomycin at-least once within a hospital were inquired with various risk factors
such as inappropriate usage, or continuation (Nak-Hyun Kima, 2014). During this timeframe, for
every 1,000 patients, 34 dosages were given on a daily basis (Nak-Hyun Kima, 2014). As we
continue to misuse, and abuse antibiotics, a disease essentially for the microbes, we encourage
the emergence of resistant strains. As a future clinician, the discussion of Vancomycin Resistance
Staphylococcus Aureus (VRSA), the epidemiology, transmission, emergence, and finally, its
importance will debated.
Alexander Fleming, a Scottish biologist brought society into a brave new world with the
discovery of Penicillium notatum, a fungus that served as a treatment for bacterial infections
(Diggins, 2003). With this scientific advancement, detrimental diseases such as syphilis, and
gangrene were being treated, decreasing the fatality, and increasing longevity (Tortora, 2014).
When a bacteria is first exposed to a new antibiotic, the treatment is highly effective, and
microbial fatality is excellent (Tortora, 2014). With these achievements in modern medicine
such as surgery, transplanted tissues, and treatment for cancer, opportunistic infections are staved
off with the usage of antibiotics (Ramanan Laxminarayan, 2013). In the article Antibiotic
resistance- the need for a global solution, it discusses the potential macroscopic effects of
antibiotic resistance such as the medical, social, and economical complications that would arise.
With modern day technological advances, we are able to maneuver between continents easily,
transmitting several of different microorganisms as we travel. The usage of agricultural
antibiotics for commercial use will breed resistance and drive the expense of future antibiotics
(Ramanan Laxminarayan, 2013).

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VRSA- A Microscopicand International Crisis
Staphylococcus aureus is a gram-positive aerobic microbe that is part of the one’s flora
located on the skin (CDC, 2013). The nomenclature Staphylococcus Aureus is translated as
“golden clusters of spheres” from Latin. Vancomycin is a narrow spectrum antibiotic that is
highly effective against staphylococci bacteria, and normally reserved to combat resistant strains
(NLM, 2013). Unlike eukaryotic cells, prokaryotic cells such as Staphylococcus are not
genetically diverse due to their method of replication (miotic division vs binary fission) (Tortora,
2014). Their lack of genetic diversity brings both pros and cons: an antibiotic can kill these
bacterias easily, but can also rapidly reproduce, and carry on their genetic information, as well as
benefiary mutations (Tortora, 2014).
As stated before, VRSA was once part of one’s normal flora that acquired a resistance
towards antibiotics (Center of Disease Control and Prevention, 2013). Much like other diseases,
malase, fever, chills are all common symptoms of VRSA, however there are two very
disgintuishing characteristics of this disease: it’s location. The formation of an absses, a pustual
pocket of infection that forms at the site of injury (MDH, 2014). There is also a possibility of a
subdermal infection that resulted from abrasion that allowed the pathogen to enter (MDH,
2014). At both sites, there is redness, swelling, pain due to the body’s nonspecific immune
response (inflammation) (Martini, 2015). The inflammatory response results from vasodilation in
order to deliver more blood, heat transference, white blood cell, segregation, diapedesis, and
oxygen to the sight in hopes to fight off the infection (Martini, 2015). The resistance of VRSA is
essentially plague that is having a major impact within the hospital setting.
One is more suspectible to a VRSA infection for many reasons such as surgery, or being
admitted into a hospital, extended perscription of antibiotics, medical tubing such as IV’s and
cathearers not being changed, weakened, or compromised immunity, and noscomial infections

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VRSA- A Microscopicand International Crisis
(Truven Health Analytics Inc, 2015). Other sources states that mucousal membranes, repiratory
and gastrointestinal tracts are also locations of concern with a staph. aureus infection (Ohio
Health Department, 2014). It is believed that VRSA and spread to various other organs or
systems to infect the individual from both localized to intravenous. The localized diseases are
denied as furuncle, impetigo, boils, and other wound infections. Intavenial infections such as
septicemia, sepesis, endocarditis, and pneumonia are also potential risks (Ohio Health
Department, 2014).
However, the area of concern is nosocomial infection when one is admitted to a hospital.
When admitted, one arrives after experiencing trauma, or crisis that would involve
hospitalization, especially when the a caregiver has to interact with the entire population, and a
hospital is understaffed. In one research article, the amount of times a care giver and patient
touched an object were quantified, and may increase the risk of transmission. The bedside railing
being one of the highest touched between both patient and care giver, as well as other top 8 items
could be a link between the transmissions of nosocomial infections between patients. (V.C.C.
Chenga, 2015). Essentially, the caregiver, whether it is a Physician, or a Patient Care Technician,
is a fomite.
In order to be diagnosed with VRSA, one needs to retrieve a sample of the site of
infection. Acquiring skin, blood, or sputum sample and sent to a laboratory for testing (Center of
Disease Control and Prevention, 2013). However, the laboratory criteria for diagnosis provides
more insight such as isolation, and quantifiable data. One needs to isolate the Staphylococcus
Aureus from the sample and there needs to be a significant amount of resistance to the antibiotic
Vancomycin (Ohio Health Department, 2014). There needs to be resistance or complete
resistance of the pathogenic isolate to vancomycin, detected and defined according to the

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VRSA- A Microscopicand International Crisis
Clinical and Laboratory Standards Institute approved standards and recommendations at
Minimum inhibitory Concentration (MIC)≥16 μg/ml for VRSA) (Ohio Health Department,
2014). However,
Armed with the background information, and knowledge, the question of what potential
consequences could arise from VRSA. As stated before, we live in a world where transportation,
and traveling is faster than ever: we can be in Japan one day, and the United State the next.
However, we also serve as reservoirs for these microbes; a warm, hospitable environment for the
microscope world. We have the capability of literally bringing our own destruction due to our
negligence, and ignorance for the consequential actions of antibiotic abuse. In fact, the first
reported incident of Vancomycin Staphylococcus Aureus was a 40 year old resident from
Michigan back in 2002, but had been isolated for diagnostic testing back in 1996 in Japan.
(Hiramatsu K, 1997). As we step into the half-way mark of 2015, we have the 14th case of VRSA
in our own backyard: Delaware County. A 67 year old patient with various underlying health
condition was being treated for an outpatient procedure. (Outbreak News Today, 2015).
To reiterate, Staphylococcus Aureus is a gram-positive cluster of spheres. Bacteria that
are gram-positive have a thicker peptidoglycan cell wall than those of gram negative (Tortora,
2014). The importance of knowing whether a bacteria is gram-negative and gram-positive is due
to its medicinal properties. Ironically, in order to treat an Antibiotic resistant strain of a bacteria,
one needs to develop a more potent antibiotic. The usage of Teicoplanin as an alternative to
vancomycin has shown success when used as a treatment. However,due tothe similarityof the
glycopeptides,bacteriaquicklydevelopedresistance thisnew antibiotic(Capriotti,2007). Another
effectivedrugisa fifthgenerationcephalosporinantibioticthatisusedto combat MethicillinResistant

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VRSA- A Microscopicand International Crisis
Staphylococcus Aureus(MRSA). (MH,2009) Asa caveat,yearshave passedsince thatarticle hasbeen
published, anditispossible thatVRSA hasalreadydevelopedaresistance to Teicoplanin orCeftibiprole.
An old Chinese states “an ounce of prevention is better than a pound of cure. There are
ways that VRSA can be prevented while working in a clinical setting. By using proper infection
practices such as wearing gloves, frequent hand washing and monitoring what one touches, one
is able to stave off the possibility of infecting, or even becoming infected (Virginia Department
of Health, 2013). Patients should be screen if they are in a population that requires close contact
such as resident homes and assisted living, prisons, half-way houses, hospitals, and even schools
(Center of Disease Control and Prevention, 2013). Those who are healthcare workers, or work in
a healthcare environment should constantly keep their hands clean with soap, or alcohol-based
hand sanitizers, and limit the contact with wounds (Virginia Department of Health, 2013).
We live in a world in which technological advancement allows us to communicate, and
interact with one another. Within a few hours, an individual has the possibility of traveling half-
way across the world. However, at the same time, this opens the potential of highly
communicable and infectious diseases such as VRSA to spread throughout the population. With
several confounding factors such as negligence, abuse, and misdiagnosis, antibiotics have been
dished out in quantities that selected for the emergence of resistance such as Vancomycin
Resistance Staph. Aureus.

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VRSA- A Microscopicand International Crisis
References
Capriotti,T.(2007). Resistant'Superbugs'CreateNeed forNovelAntibiotics.RetrievedfromMedscape.
Centerof Disease Control andPrevention,C.(2013, August22). General Information aboutVISA/VRSA.
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http://www.cdc.gov/HAI/organisms/visa_vrsa/visa_vrsa.html
Diggins,F.(2003). he true history of the discovery of penicillin by AlexanderFleming. Insititute of
Biomedical Sciences,London:Biomedical Scientist.
HiramatsuK, H. H. (1997). Methicillin-resistantStaphylococcusaureusclinical strain with reduced
vancomycin susceptibility.
Martini,N. B. (2015). Fundamentalsof Anatomy &Physiology. Boston,MA:PearsonLearning.
MH, K.(2009, Dec). New antimicrobialagentsformethicillin-resistantStaphylococcusaureus.Retrieved
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Nak-HyunKima,H.L.-H.-d.(2014, November17). InappropriateContinuedEmpiricalVancomycin Usein
a Hospitalwith a High Prevalenceof Methicillin-ResistantStaphylococcusaureus.Retrievedfrom
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aureus(VISA);Vancomycin ResistantStaphylococcusaureus(VRSA).RetrievedfromOhio
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OutbreakNewsToday.(2015, March 13). VRSA reported in Delaware patient,14th case ever reported in
US.RetrievedfromOutbreakNewsToday:http://outbreaknewstoday.com/vrsa-reported-in-
delaware-patient-14th-case-ever-reported-in-us-42673/
Ramanan Laxminarayan,P.(2013, November17). Antibioticresistance—theneed forglobalsolutions.
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VRSA- A Microscopicand International Crisis
V.C.C.Chenga,b.P.(2015, July). Hand-touchcontactassessmentof high-touch and mutual-touch
surfacesamong healthcareworkers,patients,and visitors.RetrievedfromScience Direct:
http://www.sciencedirect.com/science/article/pii/S0195670115001012
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http://www.vdh.virginia.gov/Epidemiology/factsheets/pdf/VISA_VRSA.pdf