To study the infections caused by methicillin resistant Staphylococcus aureus (MRSA) with emphasis on heterogeneous vancomycin intermediate S. aureus (hVISA) in diabetic and non-diabetic patients and their comparison. Patients and Methods: S. aureus strains isolated from diabetic and non-diabetic patients admitted in four tertiary care hospitals in Coastal Karnataka, South India, were tested for methicillin resistance and included in the present study. Demographic and clinical data of the patients were collected using structured proforma. Antimicrobial susceptibility testing was done using the Kirby-Bauer disc diffusion method, and MLS B phenotypes were identified using the D-test. The minimum inhibitory concentration (MIC) of vancomycin was determined using agar dilution. MRSA isolates were tested for hVISA using vancomycin screen agar and population analysis profile -area under the curve (PAP-AUC) test. Statistical analysis of the results was done using the chi-square test. SPSS version 29.0 was used for this purpose. Results: Out of 665 strains of S. aureus isolated, 220 (33.1%) were MRSA. Of these 220 MRSA strains, 122 (55.5%) and 98 (44.5%) were isolated from diabetic and non-diabetic patients, respectively. There was no significant difference in the antimicrobial resistance patterns of MRSA strains isolated from diabetic and non-diabetic patients. Foot infections and osteomyelitis caused by MRSA were significantly more among diabetic patients. Out of 220 strains of MRSA, 14 (6.4%) were hVISA. The rates of hVISA among MRSA isolated from diabetic and non-diabetic were 9.0% and 3.1%, respectively. This difference was statistically not significant. Conclusion:The rate of hVISA among all MRSA isolates was 6.4%. The risk of hVISA infection was three times more in diabetic patients. The results emphasize the importance of the detection of hVISA among MRSA isolates especially from diabetic patients.
Objectives: This study aimed to detect heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) among methicillin resistant S. aureus (MRSA) isolated from healthcare-associated infections and identify staphylococcal cassette chromosome mec (SCCmec) types. Methods: Isolation and identification of MRSA were done using standard bacteriological methods. Antimicrobial susceptibility testing was done using Kirby-Bauer disc diffusion and macrolide-lincosamide-streptogramin B (MLSB) phenotypes identified using D test. The minimum inhibitory concentration (MIC) of vancomycin was determined using agar dilution. hVISA were confirmed by modified population analysis profile-area under the curve (PAP-AUC) test. SCCmec types and Panton-Valentine leukocidin (pvl) were detected using multiplex PCR. Results: Out of 220 MRSA stains, 14 (6.4%) were hVISA. None of the MRSA isolate was vancomycin intermediate or resistant. All hVISA were susceptible to linezolid and teicoplanin. Macrolide-streptogramin B (MSB) phenotype was present in 42.9% hVISA. 92.9% hVISA strains had vancomycin MIC in the range 1-2 µg/mL. Majority of hVISA and vancomycin susceptible MRSA were isolated from skin and soft tissue infections. SCCmec III and IV were present in 50% and 35.7% hVISA respectively. 14.3% hVISA harboured SCCmec V. Conclusion: The rate of hVISA among MRSA was 6.4%. MRSA strains should be tested for hVISA before starting vancomycin treatment. None of the isolates was vancomycin intermediate or resistant. All the hVISA strains were susceptible to linezolid and teicoplanin. The majority of hVISA were isolated from skin and soft tissue infections. The majority hVISA harboured SCCmec III and IV. Keywords: MRSA; Hospital infection; Molecular typing; Vancomycin
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