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Clinical Significance of Antibiotic Resistance01:25

Clinical Significance of Antibiotic Resistance

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Methicillin-resistant Staphylococcus aureus (MRSA) presents a critical public health threat, arising from its capacity to resist β-lactam antibiotics due to acquisition of the mecA gene within the staphylococcal cassette chromosome mec (SCCmec). This gene encodes penicillin-binding protein 2a (PBP2a), which impairs binding efficacy of methicillin and other β-lactams. MRSA has evolved into distinct clonal lineages impacting humans and animals alike, reinforcing its significance within...
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Heterogeneous vancomycin-intermediate among methicillin resistant Staphylococcus aureus.

C N Chaudhari1, K Tandel2, N Grover3

  • 1Professor (Microbiology), INHS Asvini Colaba, Mumbai, India.

Medical Journal, Armed Forces India
|January 23, 2015
PubMed
Summary
This summary is machine-generated.

Hetero-resistance vancomycin intermediate Staphylococcus aureus (hVISA) is a challenge for vancomycin treatment. While PAP-AUC is unsuitable for labs, BHIA6V, MET, and E tests show variable results for hVISA screening.

Keywords:
MRSAPAP-AUCVancomycinhVISA

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Area of Science:

  • Clinical microbiology
  • Infectious diseases
  • Antimicrobial resistance

Background:

  • Hetero-resistance vancomycin intermediate Staphylococcus aureus (hVISA) presents a challenge as it tests susceptible (VSSA) but harbors intermediate (VISA) populations, leading to vancomycin treatment failures.
  • Population Analysis Profile-Area under Curve (PAP-AUC) is a gold standard for hVISA detection but is impractical for routine clinical laboratories.
  • Alternative methods like Brain Heart Infusion Agar with 6 μg/ml vancomycin (BHIA6V), E test, and Macromethod E test (MET) have shown variable performance in identifying hVISA.

Purpose of the Study:

  • To evaluate the performance of PAP-AUC, BHIA6V, MET, and E test in detecting hVISA among clinical Methicillin-resistant S. aureus (MRSA) isolates.
  • To determine the prevalence of hVISA in a cohort of MRSA isolates.
  • To assess the clinical utility of available screening methods for hVISA detection.

Main Methods:

  • Analysis of 58 clinical MRSA isolates with vancomycin MIC >1 μg/ml using E test and agar dilution.
  • Comparison of PAP-AUC, BHIA6V, and MET methods for hVISA detection.
  • Correlation of PAP-AUC ratios with vancomycin MICs obtained from E test and MET.

Main Results:

  • The prevalence of hVISA was determined to be 6.9% among the studied MRSA isolates.
  • hVISA isolates exhibited vancomycin E test MICs >2 μg/ml.
  • Sensitivities for BHIA6V, MET, and E test (MIC >2 μg/ml) were 0.75, 0.67, and 1.0, respectively, with corresponding positive predictive values (PPV) of 0.43, 0.4, and 0.27 when compared to PAP-AUC.

Conclusions:

  • Screening of MRSA isolates with in-vitro vancomycin susceptibility ≤2 μg/ml by agar dilution is recommended for hVISA detection.
  • PAP-AUC is not suitable for routine laboratory diagnostics due to its impracticality.
  • BHIA6V, MET, and E tests can serve as screening tools for hVISA, but their low PPVs necessitate careful interpretation and further confirmatory testing.