Comparison of the clinical features, bacterial genotypes and outcomes of patients with bacteraemia due to heteroresistant vancomycin-intermediate Staphylococcus aureus and vancomycin-susceptible S. aureus

Abstract

The hVISA phenotype was present in more than one-third of MRSA isolates and was independently associated with several baseline factors. Although this phenotype did not affect patient outcomes, our results indicate that targeting an initial vancomycin trough of 15-20 mg/L may be beneficial in patients with hVISA bacteraemia.

Treatment options for methicillin-resistant Staphylococcus aureus (MRSA) infection: Where are we now?

“…hVISA is not associated with high mortality but with increased failure rates, suggesting that resistance may have a fitness cost [27][28][29][30]. According to this information, it would be interesting for the clinical management of severe S. aureus bacteraemia treated with vancomycin to know the presence of heteroresistance.…”

Clinical and Molecular Characterization of Invasive Heteroresistant Vancomycin-Intermediate Staphylococcus aureus Infections in Korean Hospitals

“…However, the prevalence of h-VISA in a recent study by Park el al. (4) in one tertiary Korean hospital was relatively high (37.7%). Those workers performed a population analysis of all blood MRSA isolates without initial screening for h-VISA on BHI V4, and this may be one reason for the high h-VISA prevalence that they observed.…”

“…However, the prevalence of h-VISA among cases of methicillin-resistant S. aureus (MRSA) bacteremia reached 37.7% in a recent study performed in a Korean hospital (4). We conducted a multicenter study to evaluate the prevalence of h-VISA among cases of invasive S. aureus (ISA) infection.…”

Vancomycin: The Tale of the Vanquisher and the Pyrrhic Victory

“…In another study of 268 MRSA bacteremias, 37.7% were characterized as hVISA; those infections occurred especially in patients who had undergone prior vancomycin therapy and were using immunosuppressive drugs (18). Although overall mortality was similar for hVISA and vancomycin-susceptible S. aureus, hVISA was associated with persistent bacteremia when initial trough levels of vancomycin were less than 15 mg/L (18). A meta-analysis of 22 studies reported that a high vancomycin MIC (≥1.5 mg/L vs <1.5 mg/L) was associated with higher attributed mortality and treatment failure (19).…”

“…The patients were more likely to have a high bacterial load, vancomycin treatment failure, and initially low serum vancomycin levels (17). In another study of 268 MRSA bacteremias, 37.7% were characterized as hVISA; those infections occurred especially in patients who had undergone prior vancomycin therapy and were using immunosuppressive drugs (18). Although overall mortality was similar for hVISA and vancomycin-susceptible S. aureus, hVISA was associated with persistent bacteremia when initial trough levels of vancomycin were less than 15 mg/L (18).…”