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Recent ominous developments in clinical microbiology include reports of Staphylococcus aureus that are entirely or partially resistant to vancomycin (VRSA and VISA, respectively). Because almost all these organisms have had intrinsic methicillin resistance, choices for effective antibiotics have been limited to newer agents such as linezolid and daptomycin. Researchers now report VISA in an isolate of S. aureus with preserved methicillin susceptibility.
A patient who was receiving long-term oxacillin for spinal osteomyelitis developed hepatotoxicity, which was presumed to be oxacillin-related: Vancomycin was substituted. After receiving 8 weeks of vancomycin with documented therapeutic blood levels, the patient experienced breakthrough S. au…