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Ceftaroline-heteroresistant Staphylococcus aureus.

Stephanie N Saravolatz1, Hayley Martin1, Joan Pawlak1

  • 1St. John Hospital and Medical Center and Wayne State University School of Medicine, Detroit, Michigan, USA.

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Ceftaroline heteroresistance was found in 21% of tested Staphylococcus aureus strains, indicating subpopulations with reduced susceptibility. This heteroresistance was unstable and occurred in strains with reduced susceptibility to other antibiotics.

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Area of Science:

  • Microbiology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Heteroresistance describes susceptible microbial populations containing subpopulations with reduced susceptibility to antimicrobials.
  • Ceftaroline is a cephalosporin effective against methicillin-resistant Staphylococcus aureus (MRSA).

Purpose of the Study:

  • To investigate the prevalence of ceftaroline heteroresistance in vitro among various Staphylococcus aureus isolates.
  • To characterize ceftaroline-heteroresistant S. aureus (CHSA) in relation to other antimicrobial resistance profiles.

Main Methods:

  • Evaluated 57 Staphylococcus aureus isolates, including MRSA, vancomycin-intermediate S. aureus (VISA), daptomycin-nonsusceptible S. aureus (DNSSA), linezolid-nonsusceptible S. aureus (LNSSA), and heteroresistant VISA (hVISA).
  • Determined minimum inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBCs) via broth microdilution.
  • Utilized population analysis profiles (PAPs) on agar with varying ceftaroline concentrations to detect heteroresistance.

Main Results:

  • 12 out of 57 (21%) S. aureus isolates exhibited ceftaroline heteroresistance (CHSA).
  • CHSA was observed in strains with reduced susceptibility to vancomycin, daptomycin, and linezolid.
  • No CHSA was detected in the USA-300 isolates tested; the heteroresistant phenotype was unstable.

Conclusions:

  • Ceftaroline heteroresistance is present in a significant proportion of S. aureus isolates with reduced susceptibility to other antibiotics.
  • The instability of the CHSA phenotype warrants further investigation.
  • Additional research is necessary to determine the clinical significance of CHSA and its impact on treatment outcomes.