ScienceBlogling Revere links to a news article about high levels of VRE, vancomycin resistant enterococci in beach sand. While Revere and the article both describe how this indicates that VRE are established in the community, I think a far more chilling problem isn’t mentioned at all: VMRSA.
What’s VMRSA? Vancomycin resistant MRSA (methicillin resistant Staphylococcus aureus).
Every instance of VMRSA has involved an MRSA strain acquiring a plasmid (mini-chromosome) from a VRE strain. So far, most of these cases have occurred in Michigan. Apparently, the VRE strain that carries this particular highly transmissible plasmid is endemic to Michigan. Also, these plasmid transfer events have only occurred in very sick patients who were hospitalized, or even already in isolation–if a highly resistant strain is to evolve, this is the best place for it to happen (from the human point of view), since it’s already contained.
But if VRE has established itself outside of the hospital and in the community, we’re going to see a lot more VMRSA. And an epidemic strain only has to get lucky once…