Etest Methods for Screening Heterogeneous Vancomycin-Intermediate Staphylococcus aureus (hVISA) strains
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Etest Methods for Screening Heterogeneous Vancomycin‑Intermediate Staphylococcus aureus (hVISA) strains Min Young Lee1,2 · Woo In Lee2 · Myeong Hee Kim2 · So Young Kang2 · Young Jin Kim3 Received: 7 February 2020 / Accepted: 8 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The importance of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) as a preceding stage for the development of vancomycin-resistant S. aureus is growing. We analyzed the prevalence of hVISA among bacteremia with methicillin-resistant S. aureus (MRSA) using two Etests and evaluated the clinical characteristics and outcomes. Ninetyeight MRSA isolates from blood were collected at two University hospitals in Korea. Macrodilution Etest and glycopeptide resistance detection Etests were used for detection of hVISA. Staphylococcal cassette chromosome mec (SCCmec) typing was performed by multiplex PCR. Clinical data were collected retrospectively from patient medical records. About 30% of MRSA strains were identified as hVISA. Diabetes mellitus was associated (P = 0.047) with hVISA infections. The hVISA isolates were associated with high teicoplanin MIC and multidrug resistance (P = 0.001). SCCmec type II accounted for the majority (79.3%) of hVISA strains. The prevalence of hVISA strains was increased and can lead to the development of multidrug-resistant strains. Patients with diabetes were found to have a greater risk for infection with hVISA strains. As the impact of hVISA on clinical outcome is not yet clear, large-scale studies about clinical outcomes and optimal detection methods of hVISA are needed. In conclusion, hVISA strains have a high prevalence in bloodstream MRSA infections. Awareness of the increase in hVISA strains should motivate laboratories to establish a system to detect and monitor hVISA.
Introduction Staphylococcus aureus is associated with a wide range of relatively mild to life-threatening infections [1]. Since the emergence of methicillin-resistant S. aureus (MRSA) in the 1980s, MRSA has been associated with hospital-acquired infections, causing higher rates of morbidity and mortality [2]. Woo In Lee and Myeong Hee Kim contributed equally to this work. * Woo In Lee [email protected] * Myeong Hee Kim [email protected] 1
Department of Laboratory Medicine, Graduate School, Kyung Hee University, Seoul, Korea
2
Department of Laboratory Medicine, Kyung Hee University School of Medicine and Kyung Hee University Hospital at Gangdong, Seoul, Korea
3
Department of Laboratory Medicine, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
Vancomycin has been the first-line antibiotic treatment for MRSA infections. The first report of reduced vancomycin susceptibility was published in 1997 in Japan [3]. Since then, the medical community has paid attention to the determination of adequate resistance breakpoints for minimal inhibitory concentration (MIC) and therapeutic drug monitoring of vancomycin. The Clinical and Laborator
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