Document Detail


Heterogeneous vancomycin resistance in Staphylococcus aureus: a review of epidemiology, diagnosis, and clinical significance.
MedLine Citation:
PMID:  20332341     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To provide an overview of heterogeneously glycopeptide intermediate Staphylococcus aureus, its epidemiology, methods of diagnosis, and clinical relevance. DATA SOURCES: Literature was retrieved in December 2009 through Academic Search Premier, Alt-Health Watch, MEDLINE, OVID, and PubMed, using the search terms heterogeneous glycopeptide-intermediate Staphylococcus aureus, hGISA, hVISA, vancomycin-intermediate Staphylococcus aureus, GISA, and VISA (from 2003 to December 2009). Additional references were obtained through review of publication citations. STUDY SELECTION AND DATA EXTRACTION: All articles retrieved through the literature search and reference review were evaluated for inclusion in this review. DATA SYNTHESIS: Heterogeneously glycopeptide-intermediate S. aureus (hGISA) has been shown to significantly complicate treatment for patients with bacteremia and often escapes detection in clinical laboratories. Population analysis profile area under the curve ratio (PAP-AUC) is considered to be the gold standard of hGISA detection; however, it is labor-intensive, expensive, and not feasible in a clinical setting. The Etest macromethod is a reasonable alternative to PAP, yielding high sensitivity and specificity, and has potential for routine use in clinical laboratories. Due to these difficulties in detection, an exact prevalence is difficult to obtain though, based on available data, it appears that approximately 5-15% of isolates display this phenotype. hGISA is associated with prolonged bacteremia, high bacterial load infections, prolonged antibiotic therapy, prolonged hospitalization, treatment failure, and potential for increased mortality. CONCLUSIONS: Overall, hGISA is associated with a poor clinical course in patients with bacteremia. Information is still lacking regarding the actual prevalence of hGISA as well as the extent of its clinical impact. A uniform method of diagnosis must be established in order to better account for all cases of hGISA. More studies must be conducted to assess clinical outcomes of hGISA.
Authors:
Star L Rong; Steven N Leonard
Publication Detail:
Type:  Journal Article; Review     Date:  2010-03-23
Journal Detail:
Title:  The Annals of pharmacotherapy     Volume:  44     ISSN:  1542-6270     ISO Abbreviation:  Ann Pharmacother     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-21     Completed Date:  2010-07-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203131     Medline TA:  Ann Pharmacother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  844-50     Citation Subset:  IM    
Affiliation:
School of Pharmacy, Northeastern University, Boston, MA 02115, USA.
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / administration & dosage,  pharmacology,  therapeutic use*
Humans
Staphylococcal Infections* / drug therapy,  epidemiology,  microbiology
Staphylococcus aureus / drug effects*,  isolation & purification,  physiology
Vancomycin / administration & dosage,  pharmacology,  therapeutic use*
Vancomycin Resistance*
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 1404-90-6/Vancomycin

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


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