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Part IV

Week 10, Day 2

“Hi, Kurt. It’s Jenna. I looked at the results. e take-home message from all of this seems to be that there is a new strain of MRSA lurking—one that lacks any identifiable risk factors.”

“Exactly, Jenna. is new strain appears to be community-acquired. We had seen it in three pediatric patients before you called me. is case makes four. Interestingly, it seems to be occuring primarily in the midwest—two cases in North Dakota and two cases, including yours, in Minnesota.”

“is definitely changes my standard therapy for kids with severe infections of the bloodstream.”

“Yes! Fortunately, you have several options. Unlike hospital-acquired MRSA infections, this community-acquired version is susceptible to several antibiotics—excluding those in the cefazolin category. We’re getting ready to publish this information. One of our main recommendations to doctors is that they treat critically ill patients harboring invasive infections with vancomycin in addition to cefazolin—aspat least until a culture report can be obtained.”

“My concern is that we’ll end up with strains that are vancomycin resistant as well. You know that studies are showing strong positive correlations between antibiotic resistance and antibiotic consumption.”

“Yours is a valid concern, but I’ve got to run. Let’s talk more about that another day.” “Sure, Kurt. anks!”

1. Speculate about the selective pressures that could have led to the emergence and increased prevalence of a new and unique strain of MRSA.

2. Why might Dr. Collins be concerned that vancomycin resistant strains will emerge as well?

“Dr. Collins and the Case of the Mysterious Infection” by Lemons & Huber

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