<i>Staphylococcus aureus</i>
            with Heterogeneous Resistance to Vancomycin: Epidemiology, Clinical Significance, and Critical Assessment of Diagnostic Methods

Liu, Catherine; Chambers, Henry F.

doi:10.1128/aac.47.10.3040-3045.2003

Cited by 296 publications

(246 citation statements)

References 40 publications

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“…The prevalence of hVISA ranges widely from 0 to 74%, depending on the geographic location, study population, and methodology used [4,13,14]. Causes for treatment failures are not fully understood: clinical failures have been reported in patients infected with VISA or hVISA strains [15].…”

Section: Discussionmentioning

confidence: 99%

Vancomycin susceptibility trends of methicillin-resistant Staphylococcus aureus isolated from burn wounds: a time for action

Zorgani

Elahmer

Abaid³

et al. 2015

J Infect Dev Ctries

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Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) with reduced susceptibility to vancomycin poses a threat for patients in burn units throughout the world. This study aimed to investigate the reduced susceptibility to vancomycin of MRSA isolated from wounds of patients admitted to the Burns and Plastic Surgery Centre in Tripoli, Libya. Methodology: All isolates were initially identified by chromagen medium then confirmed by PCR. The minimum inhibition concentration (MIC) was determined by E-test glycopeptide resistance detection (GRD). Results: During the study, 210 isolates were obtained from 560 patients representing 132 (62.9%) and 78 (37.1%) of total samples received during years 2009 and 2010, respectively. MIC levels for vancomycin ranged from 0.5 to 2 µg/ml during the study, 13% of isolates displayed MIC of 1.5 µg/ml and 9% of the isolates displayed 2 µg/ml. Although MRSA isolates decreased dramatically during 2010 (37.1%) compared to 2009 (62.9%), overall, there was a significant increase in the proportion of MRSA isolates exhibiting higher vancomycin MICs during 2010 compared to 2009 (P = 0.0155). There was a significant increase of MICs at 1 µg/ml during 2010 compared with 2009 (P = 0.36). No vancomycin intermediate or resistant strains were found. Conclusion: There was a significant increase in the proportion of MRSA isolates exhibiting higher vancomycin MICs. We recommend that MRSA isolates should be monitored. Furthermore, implementation of infection control measures is urgently needed to prevent the spread of MRSA.

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Section: Discussionmentioning

confidence: 99%

Vancomycin susceptibility trends of methicillin-resistant Staphylococcus aureus isolated from burn wounds: a time for action

Zorgani

Elahmer

Abaid³

et al. 2015

J Infect Dev Ctries

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“…Since 1997, S. aureus with intermediate susceptibility to vancomycin (VISA) as well as heteroresistance to vancomycin (hVISA) have been described. [4][5][6] Several centers have also noted a slow rise in minimum inhibitory concentration (MIC) among clinical MRSA isolates (''MIC creep''). 7 Low vancomycin trough levels have been implicated in the emergence of hVISA, and several studies have demonstrated a higher rate of vancomycin treatment failure, longer duration of fever, and prolonged hospitalization with hVISA and strains with elevated MIC compared to vancomycin-susceptible MRSA.…”

mentioning

confidence: 99%

Elevated vancomycin trough is not associated with nephrotoxicity among inpatient veterans

Prabaker

Tran

Pratummas

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Vancomycin troughs of 15‐20 mg/L are recommended in the treatment of invasive staphylococcal disease, higher levels than previously recommended.OBJECTIVE/SETTING:We sought to determine if there was an association between vancomycin trough and nephrotoxicity, defined as 0.5 mg/L or 50% increase in serum creatinine, at a large Veterans Affairs medical center.PATIENTS AND METHODS:We reviewed records of 348 inpatients at our institution who received ≥5 days of vancomycin during 2 time periods when vancomycin dosing protocols differed (May 2005‐April 2006 and January 2007‐December 2007). Potential risk factors for nephrotoxicity were collected prior to nephrotoxicity onset, and all patients with nephrotoxicity events occurring within 5 days of starting vancomycin were excluded.RESULTS:Overall incidence of nephrotoxicity was 31/348 patients (8.9%). A similar percentage of patients experienced nephrotoxicity in 2005‐2006 versus 2007 (16/201 vs 15/147, respectively; P = 0.57), despite a rise in mean (9.7 mg/L in 2005‐2006 vs 13.2 mg/L in 2007; P < 0.0001) and highest (11.8 mg/L in 2005‐2006 vs 15.7 mg/L in 2007; P < 0.0001) vancomycin trough levels achieved. In a multivariate logistic regression model, only receipt of intravenous contrast dye was significantly associated with nephrotoxicity (OR 4.01, P < 0.001), though there was a trend toward an association between maximum vancomycin trough ≥15 mg/L and nephrotoxicity (OR 2.05, P = 0.082). Overall reversibility of nephrotoxicity either prior to or within 72 hours of vancomycin discontinuation was 77.8%.CONCLUSIONS:We conclude that nephrotoxicity, with higher trough levels occurring at ≥5 days of vancomycin therapy, was uncommon at our institution and typically reversible. Journal of Hospital Medicine 2012;. © 2011 Society of Hospital Medicine

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“…En el caso de vancomicina, las cepas hVISA tienen subpoblaciones de células con resistencia intermedia (CIM entre 8 y 16 µg/ml), mientras la CIM global está en el rango de susceptibilidad (< 4 µg/ml). La vancomicina crea una presión selectiva que favorece el predominio de las subpoblaciones de células más resistentes, generando hVISA y, eventualmente, con la exposición continua, una población uniforme de VISA (53). La primera cepa hVISA, Mu3, fue aislada en Japón en 1996 en un paciente de 64 años con neumonía por MRSA tratada sin éxito con vancomicina durante 12 días, con agravamiento del cuadro en los últimos 4 días de terapia.…”

Section: Resistencia Intermedia Heterogénea a Vancomicina: Cepas Hvisaunclassified

Staphylococcus aureus resistente a vancomicina.

Rodríguez¹,

Vesga

2005

biomedica

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Objetivo. Revisar la evolución y mecanismos moleculares de la resistencia de Staphylococcus aureus a vancomicina. Fuente de los datos. Se consultó la base de datos MEDLINE y se seleccionaron artículos tipo reportes de caso, estudios bioquímicos, de microscopía electrónica y biología molecular pertinentes. Síntesis. Después de casi 40 años de eficacia ininterrumpida de la vancomicina, en 1997 se reportaron los primeros casos de fracaso terapéutico debido a cepas de Staphylococcus aureus con resistencia intermedia, denominadas VISA (concentración inhibitoria mínima, CIM, 8 a 16 µg/ml), así como a cepas con resistencia heterogénea hVISA (CIM global = 4 µg/ml, pero con subpoblaciones VISA), en las cuales la resistencia está mediada por engrosamiento de la pared celular y disminución de su entrecruzamiento, lo que afecta la llegada del antibiótico al blanco principal, los monómeros del peptidoglicano en la membrana plasmática. En 2002 se aisló la primera de las 3 cepas reportadas hasta la fecha con resistencia total al antibiótico, denominadas VRSA (CIM>32 µg/ml), en las que se encontró el transposón Tn1546 proveniente de Enterococcus spp, responsable del reemplazo de la terminación D-Ala-D-Ala por D-Ala-Dlactato en los precursores de la pared celular con pérdida de la afinidad por el glicopéptido. Conclusiones. La resistencia a vancomicina es una realidad en S. aureus, mediada en el caso de VISA por alteraciones en la pared celular que atrapan el antibiótico antes de llegar al sitio de acción, y en el caso de VRSA, por transferencia desde Enterococcus spp. de genes que llevan a la modificación del blanco molecular.Palabras clave: Staphylococcus aureus, peptidoglicano, biosíntesis, antibióticos glicopéptidos, vancomicina, resistencia microbiana a drogas, resistencia a vancomicina. Vancomycin-resistant Staphylococcus aureusThe evolution and molecular mechanisms of vancomycin resistance in Staphylococcus aureus were reviewed. Case reports and research studies on biochemestry, electron microscopy and molecular biology of Staphylococcus aureus were selected from Medline database and summarized in the following review. After almost 40 years of successful treatment of S. aureus with vancomycin, several cases of clinical failures have been reported (since 1997). S. aureus strains have appeared with intermediate susceptibility (MIC 8-16 µg/ml), as well as strains with heterogeneous resistance (global MIC ≤ 4 µg/ml), but with subpopulations of intermediate susceptibility. In these cases, resistance is mediated by cell wall thickening with reduced cross linking. This traps the antibiotic before it reaches its major target, the murein monomers in the cell membrane. In 2002, a total vancomycin resistant strain (MIC ≥ 32 µg/ml) was reported with vanA genes from Enterococcus spp. These genes induce the change of D-Ala-D-Ala terminus for D-Ala-D-lactate in the cell wall precursors, leading to loss of affinity for glycopeptides. Vancomycin resistance in S. aureus has appeared; it is mediated by cell wall modifications that trap the ...

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Staphylococcus aureus with Heterogeneous Resistance to Vancomycin: Epidemiology, Clinical Significance, and Critical Assessment of Diagnostic Methods

Cited by 296 publications

References 40 publications

Vancomycin susceptibility trends of methicillin-resistant Staphylococcus aureus isolated from burn wounds: a time for action

Vancomycin susceptibility trends of methicillin-resistant Staphylococcus aureus isolated from burn wounds: a time for action

Elevated vancomycin trough is not associated with nephrotoxicity among inpatient veterans

Staphylococcus aureus resistente a vancomicina.

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