Systematic Review and Meta-Analysis of the Epidemiology of Vancomycin-Intermediate and Heterogeneous Vancomycin-Intermediate Staphylococcus aureus Isolates

Abstract

BackgroundVancomycin-intermediate Staphylococcus aureus (VISA) and heterogeneous VISA (hVISA) are associated with vancomycin treatment failure, and are becoming an increasing public health problem. Therefore, we undertook this study of 91 published studies and made subgroup comparisons of hVISA/VISA incidence in different study years, locations, and types of clinical samples. We also analyzed the genetic backgrounds of these strains.MethodsA systematic literature review of relevant articles published in PubMed and EMBASE from January 1997 to August 2014 was conducted. We selected and assessed journal articles reporting the prevalence rates of hVISA/VISA.ResultsThe pooled prevalence of hVISA was 6.05% in 99,042 methicillin-resistant S. aureus (MRSA) strains and that of VISA was 3.01% in 68,792 MRSA strains. The prevalence of hVISA was 4.68% before 2006, 5.38% in 2006–2009, and 7.01% in 2010–2014. VISA prevalence was 2.05%, 2.63%, and 7.93%, respectively. In a subgroup analysis of different isolation locations, the prevalence of hVISA strains was 6.81% in Asia and 5.60% in Europe/America, and that of VISA was 3.42% and 2.75%, respectively. The frequencies of hVISA isolated from blood culture samples and from all clinical samples were 9.81% and 4.68%, respectively, and those of VISA were 2.00% and 3.07%, respectively. The most prevalent genotype was staphylococcal cassette chromosome mec (SCCmec) II, which accounted for 48.16% and 37.74% of hVISA and VISA, respectively. Sequence Type (ST) 239 was most prevalent.ConclusionThe prevalence of hVISA/VISA has been increasing in recent years, but has been grossly underestimated. Its incidence is higher in Asia than in Europe/America. hVISA is isolated from blood culture samples more often than from other samples. These strains are highly prevalent in epidemic MRSA strains. This study clarifies the epidemiology of hVISA/VISA and indicates that the detection of these strains and the control of nosocomial infections must be strengthened.

Vancomycin Intermediate and Vancomycin Resistant Staphylococcus Aureus – Mechanisms, Clinical Significance and Detection

“…A systematic review was conducted by Zhang et al which included data from Asia, Europe, Australia, and America from studies published from 1997 to 2014; these studies revealed that the rate of hVISA has gradually increased from 4.68% to 7.01% over the years. Similarly, the rate of VISA has also increased and the rate of VISA which was initially 2.05% has increased to 7.93% at present [27]. According to this study, the rate of VISA was 3.42% in Asia and 2.75% in Europe/America while hVISA had a rate of 6.81% in Asia and 5.60% in Europe/America.…”

“…Japan, United States, Australia, France, Brazil, Scotland, South Korea, Hong Kong, South Africa, Thailand, and Israel are some of the many which have reported infection due to hVISA and VISA [16,26]. The rate of VISA varies from 0.04% to 44.9% in Asian countries, in America a rate of 0-28.6% has been recorded while a rate of 0.07-31.7% has been seen in European countries [25,27,28]. A systematic review was conducted by Zhang et al which included data from Asia, Europe, Australia, and America from studies published from 1997 to 2014; these studies revealed that the rate of hVISA has gradually increased from 4.68% to 7.01% over the years.…”

Molecular Typing and Resistance Profiles of Vancomycin-IntermediateStaphylococcus aureusin Korea: Results from a National Surveillance Study, 2007-2013

“…This differences in prevalence may be due to the period of the study or sample size. Additionally, a recent systematic review summarized 91 published studies from throughout the world comparing of incidence of S. aureus with reduced susceptibility to vancomycin (hVISA/VISA) in different study year, locations, and types of clinical samples [25]. The prevalence of hVISA could be attributed to several factors, including differences in test strategies, geographic regions, and study populations.…”

Sequential Evolution of Vancomycin-Intermediate Resistance Alters Virulence in Staphylococcus aureus: Pharmacokinetic/Pharmacodynamic Targets for Vancomycin Exposure

“…Despite the successful use of vancomycin to combat community-associated (CA) methicillin-resistant S. aureus (MRSA) for several decades, the spread of vancomycin-intermediate S. aureus (VISA) has brought the utility of vancomycin into question (4,11). The genetic basis for VISA is unknown, although reduced vancomycin susceptibility has been associated with dysfunction of the accessory gene regulator (agr), the master regulator of pathogenicity in S. aureus (12)(13)(14).…”