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Etest Methods for Screening Heterogeneous Vancomycin-Intermediate Staphylococcus aureus (hVISA) strains.

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  • 1Department of Laboratory Medicine, Graduate School, Kyung Hee University, Seoul, Korea.

Current Microbiology
|August 1, 2020
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Summary

Heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) is increasingly prevalent in bloodstream infections caused by methicillin-resistant S. aureus (MRSA). Patients with diabetes are at higher risk for hVISA infections, which are associated with multidrug resistance.

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Area of Science:

  • Infectious Diseases
  • Microbiology
  • Clinical Medicine

Background:

  • Heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) represents a critical precursor to vancomycin-resistant S. aureus.
  • The increasing prevalence of hVISA poses a significant threat in clinical settings, particularly in bloodstream infections.

Purpose of the Study:

  • To determine the prevalence of hVISA among methicillin-resistant S. aureus (MRSA) bacteremia.
  • To evaluate the clinical characteristics and outcomes associated with hVISA infections.
  • To identify risk factors and resistance patterns linked to hVISA.

Main Methods:

  • Analysis of 98 MRSA isolates from blood cultures at two Korean university hospitals.
  • Detection of hVISA using Macrodilution Etest and glycopeptide resistance detection Etests.
  • Staphylococcal cassette chromosome mec (SCCmec) typing via multiplex PCR and retrospective collection of clinical data.

Main Results:

  • Approximately 30% of MRSA strains were identified as hVISA.
  • hVISA infections were significantly associated with diabetes mellitus (P=0.047).
  • hVISA isolates exhibited higher teicoplanin Minimum Inhibitory Concentrations (MIC) and multidrug resistance (P=0.001), with SCCmec type II being predominant (79.3%).

Conclusions:

  • hVISA demonstrates a high prevalence in MRSA bloodstream infections, highlighting the need for enhanced laboratory detection and monitoring systems.
  • The rise in hVISA strains may contribute to the development of multidrug-resistant organisms.
  • Patients with diabetes mellitus are identified as a vulnerable group at increased risk for hVISA infections.