Current status of vancomycin susceptibility against methicillin resistant Staphylococcus aureus (MRSA) strains: A study at two tertiary care hospitals of Pakistan

Kaleem, Fatima; Usman, Javaid; Sattar, Abdul; Amanat, Samina; Hassan, Ali; Omair, Muhammad; Khalid, Ali; Riaz, Muhammad

doi:10.5897/ajmr11.787

Cited by 7 publications

(11 citation statements)

References 8 publications

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“…One study from Pakistan which investigated the antibiotic resistance pattern in clinical isolates of S. aureus, reported only one isolate as vancomycin-resistant (Kaleem et al, 2012). We however found 23 out of 250 S. aureus isolates (9.2%) to be vancomycin-resistant (Table 2).…”

Section: Discussioncontrasting

confidence: 53%

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Vancomycin-ResistantStaphylococcus aureusisolates among hospitalized patients; a tertiary medical care center experience from Southern Iran

2016

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Background and Objective: Bacterial resistance to different types of antibiotics has been globally emerging over recent years. The present study was carried out to investigate the rate of vancomycin-resistant Staphylococcus aureus (VRSA) at a tertiary medical care center in Kerman, Iran. Materials and Methods: In this cross-sectional study, 250 samples with positive culture for coagulase-positive S. aureus, taken from the suspected infectious sites of patients admitted to different medical and surgical wards at Bahonar hospital from 2009 to 2011, were studied. Results: 9.2% of S. aureus isolates were found to be vancomycin-resistant. There was no significant difference in the rate of resistance between males and females (8 vs. 12.9%, respectively). Though the rate of resistance was shown to be marginally higher in post-surgical compared to medical ward patients, the difference was statistically insignificant (p = 0.8). Across the wards, general surgery housed the largest number of patients with VRSA (20%). Conclusion: The emergence of VRSA isolates has perhaps not received a great deal of attention so far. It appears that the increasing use of vancomycin in non-complicated infections may contribute to the emergence of S. aureus isolates which turn to be vancomycin-resistant.

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Section: Discussioncontrasting

confidence: 53%

“…Treatment of VRSA is challenging and these isolates are shown to be multidrug-resistant against many available antibiotics. This makes the treatment options limited, and consequently the inadequate antibiotic therapy may lead to an increased morbidity and mortality in afflicted cases (Kaleem et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Vancomycin-ResistantStaphylococcus aureusisolates among hospitalized patients; a tertiary medical care center experience from Southern Iran

2016

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“…Similar findings have been observed in the previous study. 20 Most of the studies identified the creep phenomenon by using the E test method of susceptibility testing as done in this study. 12 E test method is more reliable, sensitive and can accurately detect small MIC changings in vancomycin.…”

Section: Discussionmentioning

confidence: 99%

“…They used traditional markers over a specific period that can disguise tendencies that occur in a given setting over a period of few years. 20 …”

Section: Discussionmentioning

confidence: 99%

Assessment of Vancomycin MIC Creep Phenomenon in Methicillin-Resistant Staphylococcus aureus isolates in a Tertiary Care Hospital of Lahore

et al. 2020

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Objective: To assess vancomycin MIC creep phenomenon in methicillin-resistant Staphylococcus aureus isolated from clinical specimens. Methods: This descriptive study was conducted in Microbiology department of University of Health Sciences, Lahore from January 2016- December 2019. In this study, vancomycin MICs were revealed by E test method for clinical MRSA strains. For the final evaluation, a single isolate from each patient was taken. The reported vancomycin MICs results were used and the values were not rounded up to the next upward value. For every study year, MIC50, MIC90, median and geometrical mean MIC, percentages of susceptible and resistant strains were calculated. Results: A total of 352 MRSA strains were isolated out of 2704 staphylococcal isolates. Our study showed elevated vancomycin MIC among MRSA isolates. The majority of isolates showed MIC values ≥1.5µg/ml. MIC50, MIC 90 was constant throughout four years period. However, geometric mean MIC increased gradually during the study period. The MIC greater than base year median was overall 17.3%. A complete shift can be observed between MIC “1.0” and “2.0” the percent of cases with MIC “1.0” decreased and with MIC “2.0” increased over time crossing each other in 2017. Conclusion: Vancomycin MIC creep was identified in clinical isolates of MRSA, during four years of study period. Even though there is an absence of VISA and VRSA strains; this significant increase in vancomycin MIC trend is indeed worrying for the clinicians about the threat of potential failure of treatment in MRSA infections. doi: https://doi.org/10.12669/pjms.36.7.3273 How to cite this:Arshad F, Saleem S, Jahan S, Tahir R. Assessment of Vancomycin MIC Creep Phenomenon in Methicillin-Resistant Staphylococcus aureus isolates in a Tertiary Care Hospital of Lahore. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.3273 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Many studies around the world have evaluated the comparative efficacy of the two methods using E-strip and Agar Dilution but limited work has been done in Pakistan. A study was done in Army Medical College 11 using only E-strips method to calculate VISA and VRSA rates, however, the results obtained were not compared to any of the reference methods recommended by CLSI. The comparison of the two method in our study, will also enable us to implement the best option for calculating the MIC of vancomycin in our present setup and also at the same time gives us an insight whether E-strip can be a reliable method for detecting VISA/VRSA.…”

Section: Introductionmentioning

confidence: 99%

Comparative in- Vitro Evaluation of Vancomycin Minimum Inhibitory Concentrationby Agar Dilution and E-Strip in Methicillin Resistant Staphylococcus Aureus

Ilyas

Munir

Sadaf

et al. 2021

PAFMJ

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Objective: To compare the in-vitro efficacy by determining Minimum Inhibitory Concentration of Vancomycinusing the reference Agar Dilution to the E-Strip in Methicillin Resistant Staphylococcus aureus isolates. Study Design: Validation study. Place and Duration of Study: The department of Microbiology Army Medical College/National University ofMedical Sciences in collaboration with Pak Emirates Military Hospital Rawalpindi, from Dec 2016 to Dec 2017. Methodology: Non-duplicate 84 isolates of Methicillin resistant Staphylococcus aureus from various clinical specimens were included in the study. All these isolates were screened for susceptibility to glycopeptide by E-strips method (Bio mérieux) as well as Agar Dilution method, using vancomycin concentrations of 0.25, 0.50, 1.00, 2.00, 4.00 and 8.00µgm/ml respectively in two fold serial dilutions. Results: There was an overall agreement on 83 samples by both the methods i.e. 83 were Vancomycin SensitiveStaphylococcus aureus by both methods while one isolate with intermediate resistance to Vancomycin was onlydetected by Agar Dilution. The sensitivity of the E–strips compared to Agar Dilution was found to be 100%. Thepositive predictive value was 98.8% with a diagnostic accuracy of 98.8%. Specificity and negative predictive valuecould not be ascertained for E-strips because of the limitation of the method to detect the Vancomycin Intermediate Staphylococcus aureus isolates. Conclusion: E-strip can be a convenient alternative to the gold standard Agar Dilution but its inability to identifyVISA challenges its reliability in determining the Vancomycin resistance in MRSA isolates.

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Current status of vancomycin susceptibility against methicillin resistant Staphylococcus aureus (MRSA) strains: A study at two tertiary care hospitals of Pakistan

Cited by 7 publications

References 8 publications

Vancomycin-ResistantStaphylococcus aureusisolates among hospitalized patients; a tertiary medical care center experience from Southern Iran

Vancomycin-ResistantStaphylococcus aureusisolates among hospitalized patients; a tertiary medical care center experience from Southern Iran

Assessment of Vancomycin MIC Creep Phenomenon in Methicillin-Resistant Staphylococcus aureus isolates in a Tertiary Care Hospital of Lahore

Comparative in- Vitro Evaluation of Vancomycin Minimum Inhibitory Concentrationby Agar Dilution and E-Strip in Methicillin Resistant Staphylococcus Aureus

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