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Related Experiment Videos

The VISA/GISA problem: therapeutic implications.

J Liñares1

  • 1Microbiology Department, Ciutat Sanitària i Universitària de Bellvitge, Barcelona, Spain. fina.linares@csub.scs.es

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|November 2, 2001
PubMed
Summary
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The emergence of vancomycin-intermediate resistant Staphylococcus aureus (VISA), now termed glycopeptide-intermediate S. aureus (GISA), is a growing concern. Early detection and control programs are crucial to prevent the spread of these difficult-to-treat infections.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Vancomycin is a critical treatment for methicillin-resistant Staphylococcus aureus (MRSA) infections.
  • The emergence of vancomycin-intermediate resistant Staphylococcus aureus (VISA) strains poses a significant threat to MRSA infection management.
  • VISA strains, often resistant to teicoplanin, are now more appropriately termed glycopeptide-intermediate S. aureus (GISA).

Observation:

  • GISA isolates have been reported globally, though their frequency is currently low (10 documented infections worldwide).
  • Heterogeneous resistance to glycopeptides (h-GISA) has been observed, characterized by subpopulations growing at higher vancomycin concentrations (4-8 mg/L).
  • While GISA strains exhibit resistance to multiple antimicrobials, they remain susceptible to co-trimoxazole and some other common antibiotics.

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Findings:

  • GISA strains demonstrate reduced susceptibility to vancomycin, with reported Minimum Inhibitory Concentrations (MICs) of 8 mg/L.
  • h-GISA strains show vancomycin MICs of 1-4 mg/L but possess resistant subpopulations, indicating a potential progression to full GISA.
  • In vitro and in vivo studies suggest potential synergistic activity between glycopeptides and beta-lactams against GISA.

Implications:

  • Effective control strategies are essential to prevent the widespread dissemination of GISA.
  • Rational antibiotic policies, including reduced glycopeptide use, are recommended.
  • Rapid laboratory detection of GISA and h-GISA is crucial for timely intervention and treatment.
  • Development of new therapeutic agents and combination therapies is needed to combat GISA infections.
  • Establishing clear treatment guidelines for GISA infections is a priority.