Low Colonization Prevalence of Staphylococcus aureus with Reduced Vancomycin Susceptibility among Patients Undergoing Hemodialysis in the San Francisco Bay Area

Eguía, José M.; Liu, Catherine; Moore, Matthew R.; Wrone, Elizabeth M.; Pont, Joan; Gerberding, Julie L.; Chambers, Henry F.

doi:10.1086/429906

Cited by 19 publications

(14 citation statements)

References 36 publications

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“…Therefore, it could not be determined whether higher MICs that were still within the susceptible range were associated with treatment failure. Furthermore, The Antimicrobial Susceptibility Testing subcommittee of 14 Our study did not examine the adequacy of medical and surgical therapy for MRSA infections other than the antibiotic regimen given, removal of catheters in cases of bloodstream infections, and the presence or absence of surgical therapy in bone and joint infections. It is conceivable that other aspects of the medical and surgical treatment could be responsible for a portion of the failure rate.…”

Section: Discussionmentioning

confidence: 99%

Clinical failures of appropriately-treated methicillin-resistant Staphylococcus aureus infections

Dombrowski

Winston

2008

Journal of Infection

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Section: Discussionmentioning

confidence: 99%

Clinical failures of appropriately-treated methicillin-resistant Staphylococcus aureus infections

Dombrowski

Winston

2008

Journal of Infection

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“…Sixteen patients (6%) were positive for hVISA. Several research groups have addressed the prevalence of hVISA infections (6,10,11,17), and the frequency of hVISA in these publications is in the range of 0 to 74%. A review that summarized data from several studies (11) reported a prevalence of 1.64%.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Characteristics of Heteroresistant Vancomycin-Intermediate Staphylococcus aureus Bacteremia in a Tertiary Care Center

et al. 2007

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Hashomer, Israel, were assessed for hVISA by using the Etest macromethod. A total of 16 patients (6%) were positive for hVISA. Resistance to teicoplanin alone and to vancomycin alone using the Etest macromethod was found in 14 and 10 patients, respectively. Standard MICs to vancomycin were between 1 to 4 mg/ml. Most of these isolates (12 of 16 [75%]) would have been missed without specific testing. The median number of bacteremic days was 4. Seven patients had positive blood cultures for more than 5 days. Twelve patients died, and for eight of these the deaths were directly related to hVISA sepsis. We found that hVISA bacteremia was prevalent in our institution, and we suggest seeking hVISA in patients with persistent S. aureus bacteremia.Infections due to methicillin-resistant Staphylococcus aureus (MRSA) are responsible for 50% of hospital acquired S. aureus infections with increasing morbidity and mortality (13). A recent meta-analysis demonstrated increased mortality in bacteremia associated with MRSA compared to methicillin-susceptible S. aureus (MSSA) (5). Glycopeptides are considered the drug of choice for treating MRSA bacteremia and sepsis. S. aureus strains with reduced vancomycin susceptibility were first reported in 1997 (9). S. aureus strains with reduced vancomycin susceptibility include vancomycin-resistant S. aureus strains (VRSA; MIC Ն 16 g/ml) and vancomycin-intermediate S. aureus strains (VISA; MIC ϭ 4 to 8 g/ml). Until 2006, the MIC for VISA was defined as 8 to 16 g/ml by the Clinical and Laboratory Standards Institute (CLSI; formerly the National Committee for Clinical Laboratory Standards), and these guidelines are still the ones approved by the U.S. Food and Drug Administration for vancomycin; the MIC for heterogeneous VISA (hVISA) strains was defined by the presence of subpopulations of VISA at a rate of 1 organism per 10 5 to 10 6 organisms (14,15,20,23). Up till April 2006 only four cases with infections due to VRSA have been reported, which exhibit the vanA gene complex found in vancomycin-resistant enterococci (2, 3, 12). A few dozen VISA strains have been reported in recent years, which have slower growth rates, thickened cell walls, and reduced levels of PBP4. The underlying genetic and biochemical mechanism by which this occurred is not known. The majority of these cases with VISA have occurred in patients who were treated with vancomycin for prolonged periods of time (7,11,19). hVISA seems to be the stage that precedes the development of VISA, and it is believed that vancomycin creates a selective pressure for these resistant strains (21).The best method for detecting hVISA is controversial. Methods are not standardized, and no clear guidelines have been issued. Population analysis profiling (PAP) is considered the gold standard, but this approach is labor-intensive and expensive. Thus, it is not realistic to use such a method for a routine service in a busy hospital setup. Various other methods used to detect hVISA were described and compared by Walsh et al. (22). Of the numerou...

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“…[67] These authors have reported that the frequency of heterogeneous VISA in their publications was in the range of 0% to 74%. [68–70] Lui et al .,69 analyzed data from several studies and reported a prevalence of 1.64%. In most of these publications, surveillance was not performed routinely, the sample size was small, the studies were retrospective, or the methods for screening and identifying heterogeneous VISA varied among studies.…”

Section: Emergence Of Vancomycin Resistancementioning

confidence: 99%

Methicillin and vancomycin resistant S. aureus in hospitalized patients

Loomba

Taneja

Mishra

2010

J Global Infect Dis

176

142

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S. aureus is the major bacterial cause of skin, soft tissue and bone infections, and one of the commonest causes of healthcare-associated bacteremia. Hospital-associated methicillin-resistant S. aureus (MRSA) carriage is associated with an increased risk of infection, morbidity and mortality. Screening of high-risk patients at the time of hospital admission and decolonization has proved to be an important factor in an effort to reduce nosocomial transmission. The electronic database Pub Med was searched for all the articles on “Establishment of MRSA and the emergence of vancomycin-resistant S. aureus (VRSA).” The search included case reports, case series and reviews. All the articles were cross-referenced to search for any more available articles. A total of 88 references were obtained. The studies showed a steady increase in the number of vancomycin-intermediate and vancomycin-resistant S. aureus. Extensive use of vancomycin creates a selective pressure that favors the outgrowth of rare, vancomycin-resistant clones leading to heterogenous vancomycin intermediate S. aureus hVISA clones, and eventually, with continued exposure, to a uniform population of vancomycin-intermediate S. aureus (VISA) clones. However, the criteria for identifying hVISA strains have not been standardized, complicating any determination of their clinical significance and role in treatment failures. The spread of MRSA from the hospital to the community, coupled with the emergence of VISA and VRSA, has become major concern among healthcare providers. Infection-control measures, reliable laboratory screening for resistance, appropriate antibiotic prescribing practices and avoidance of blanket treatment can prevent long-term emergence of resistance.

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Low Colonization Prevalence of Staphylococcus aureus with Reduced Vancomycin Susceptibility among Patients Undergoing Hemodialysis in the San Francisco Bay Area

Cited by 19 publications

References 36 publications

Clinical failures of appropriately-treated methicillin-resistant Staphylococcus aureus infections

Clinical failures of appropriately-treated methicillin-resistant Staphylococcus aureus infections

Prevalence and Characteristics of Heteroresistant Vancomycin-Intermediate Staphylococcus aureus Bacteremia in a Tertiary Care Center

Methicillin and vancomycin resistant S. aureus in hospitalized patients

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