Document Detail

Detection of Staphylococcus aureus isolates with heterogeneous intermediate-level resistance to vancomycin in the United States.
MedLine Citation:
PMID:  21976769     Owner:  NLM     Status:  MEDLINE    
The prevalence of heterogeneous intermediate-level resistance to vancomycin (hVISA) in Staphylococcus aureus was assessed by screening a large collection of recent isolates. Susceptibility testing by the Clinical and Laboratory Standards Institute broth microdilution method and the Etest GRD (glycopeptide resistance detection) method (bioMérieux) was performed on 4,210 clinically significant S. aureus isolates obtained in 2009 from 43 U.S. centers. Isolates with Etest GRD-positive results for hVISA were evaluated further by repeat GRD testing and population analysis profiling-area under the curve (PAP-AUC) analysis. No VISA (vancomycin MIC, 4 to 8 μg/ml) or vancomycin-resistant (MIC ≥ 16 μg/ml) strains were detected. The Etest GRD screen for hVISA was initially positive for 68 isolates (1.6%; all by teicoplanin MIC ≥ 8 μg/ml at 24 or 48 h). Among those 68 isolates, 45 were reproducibly GRD positive. PAP-AUC testing confirmed only 11 isolates as hVISA (all had reproducible GRD-positive results). The 11 hVISA isolates were from nine medical centers and appeared genetically diverse (ten different PFGE types). The rates of resistance (including intermediate) for hVISA were as follows: oxacillin, 82%; erythromycin, 82%; clindamycin, 73%; levofloxacin, 73%; trimethoprim-sulfamethoxazole, 9%; and daptomycin, 9%. All hVISA isolates were susceptible to linezolid, tigecycline, and ceftaroline. Our data suggest that the overall prevalence of hVISA in the United States is low (0.3%). The hVISA isolates represented 10.5% of isolates with vancomycin MICs of 2 μg/ml and 0.1% of isolates with vancomycin MICs of 1 μg/ml. The positive predictive value of GRD Etest for hVISA was 16.2% for initial screen positive and 24.4% for reproducibly positive results.
Sandra S Richter; Sarah W Satola; Emily K Crispell; Kristopher P Heilmann; Cassie L Dohrn; Fathollah Riahi; Andrew J Costello; Daniel J Diekema; Gary V Doern
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-10-05
Journal Detail:
Title:  Journal of clinical microbiology     Volume:  49     ISSN:  1098-660X     ISO Abbreviation:  J. Clin. Microbiol.     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-29     Completed Date:  2012-03-01     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  7505564     Medline TA:  J Clin Microbiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  4203-7     Citation Subset:  IM    
Department of Clinical Pathology Cleveland Clinic, 9500 Euclid Avenue/L40, Cleveland, OH 44195, USA.
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MeSH Terms
Anti-Bacterial Agents / pharmacology*
Microbial Sensitivity Tests
Staphylococcal Infections / epidemiology*,  microbiology*
Staphylococcus aureus / drug effects*,  isolation & purification*
Teicoplanin / pharmacology
United States / epidemiology
Vancomycin / pharmacology*
Vancomycin Resistance*
Reg. No./Substance:
0/Anti-Bacterial Agents; 1404-90-6/Vancomycin; 61036-62-2/Teicoplanin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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