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Keikha M, Karbalaei M. Global distribution of heterogeneous vancomycin-intermediate Staphylococcus aureus strains (1997-2021): a systematic review and meta-analysis. J Glob Antimicrob Resist 2024; 37:11-21. [PMID: 38336227 DOI: 10.1016/j.jgar.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Heterogeneous vancomycin-intermediate Staphylococcus aureus is considered one of the main causes in treatment failure of vancomycin, which leads to poor clinical outcomes. Herein, we comprehensively evaluated characteristics such as global prevalence, trend, and genetic backgrounds of these strains. METHODS In this study, we conducted a meta-analysis based on PRISMA checklist 2020. In the beginning, global databases were searched to achieve the studies related to the prevalence of hVISA in clinical isolates of methicillin-resistant Staphylococcus aureus. After retrieving the eligible English studies, the prevalence of hVISA isolates and their trend changes were assessed using event rate with 95% confidence intervals. RESULTS In the present study, the prevalence of 114 801 MRSA isolates (of 124 studies) was 64%. According to our results, although the frequency of infection with hVISA is increasing in recent years, there is not a significant difference between Asian countries and Europe/America (6.1% vs. 6.8%). In addition, infection with hVISA bacteria was higher in bacteraemic patients than other infections (9.4% vs. 5.5%), which increases hospitalization, treatment costs, and mortality in these patients. Isolates harbouring SCCmec types II and III are most common genotypes in hVISA strains. CONCLUSIONS The prevalence of hVISA is increasing, which will reduce the effectiveness of vancomycin treatment in the coming years. The presence of hVISA stains in blood samples was higher than the other samples, which is threatening for bacteraemic patients. The results of the current study indicate a universal program to identify and control the spread of such strains in nosocomial infections.
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Affiliation(s)
- Masoud Keikha
- Department of Microbiology and Virology, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Mohsen Karbalaei
- Department of Microbiology and Virology, School of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran; Bio Environmental Health Hazards Research Center, Jiroft University of Medical Sciences, Jiroft, Iran.
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2
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Pardo L, Mota MI, Parnizari A, Varela A, Algorta G, Varela G. Detection of Vancomycin Resistance among Methicillin-Resistant Staphylococcus aureus Strains Recovered from Children with Invasive Diseases in a Reference Pediatric Hospital. Antibiotics (Basel) 2024; 13:298. [PMID: 38666974 PMCID: PMC11047724 DOI: 10.3390/antibiotics13040298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 04/29/2024] Open
Abstract
Vancomycin is the cornerstone in treating methicillin-resistant Staphylococcus aureus (MRSA) infections. However, therapeutic failures can occur when MRSA strains with decreased susceptibility to glycopeptides (DSG) are involved. The aim of this study was to detect and characterize DSG in MRSA recovered from children with invasive diseases at a reference pediatric hospital between 2009 and 2019. Fifty-two MRSA strains were screened using agar plates with vancomycin 3 and 4 mg/L (BHI-3 and BHI-4); the VITEK2 system; and standard and macro E-tests. Suspicious hVISA were studied by population analysis profiling-area under the curve (PAP-AUC), and wall thickness was analyzed by transmission electron microscopy. Neither VRSA nor VISA were detected in this set. As only three strains met the hVISA criteria, the PAP-AUC study included 12 additional MRSA strains that grew one colony on BHI-4 plates or showed minimum inhibitory concentrations of vancomycin and/or teicoplanin ≥ 1.5 mg/L. One strain was confirmed as hVISA by PAP-AUC. The wall thickness was greater than the vancomycin-susceptible control strain; it belonged to ST30 and carried SCCmec IV. As expected, a low frequency of hVISA was found (1.9%). The only hVISA confirmed by PAP-AUC was not detected by the screening methods, highlighting the challenge that its detection represents for microbiology laboratories.
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Affiliation(s)
- Lorena Pardo
- Bacteriology and Virology Academic Unit, Facultad de Medicina, Universidad de la República, Montevideo 11600, Uruguay; (M.I.M.); (A.P.)
- Pediatric “C” Academic Unit, Facultad de Medicina, Universidad de la República, Montevideo 11600, Uruguay
| | - María Inés Mota
- Bacteriology and Virology Academic Unit, Facultad de Medicina, Universidad de la República, Montevideo 11600, Uruguay; (M.I.M.); (A.P.)
- Bacteriology Laboratory, “Pereira Rossell” Pediatric Hospital, Montevideo 11600, Uruguay; (A.V.); (G.A.)
| | - Andrés Parnizari
- Bacteriology and Virology Academic Unit, Facultad de Medicina, Universidad de la República, Montevideo 11600, Uruguay; (M.I.M.); (A.P.)
| | - Adriana Varela
- Bacteriology Laboratory, “Pereira Rossell” Pediatric Hospital, Montevideo 11600, Uruguay; (A.V.); (G.A.)
| | - Gabriela Algorta
- Bacteriology Laboratory, “Pereira Rossell” Pediatric Hospital, Montevideo 11600, Uruguay; (A.V.); (G.A.)
| | - Gustavo Varela
- Bacteriology and Virology Academic Unit, Facultad de Medicina, Universidad de la República, Montevideo 11600, Uruguay; (M.I.M.); (A.P.)
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3
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Bacterial heteroresistance: an evolving novel way to combat antibiotics. Biologia (Bratisl) 2021. [DOI: 10.1007/s11756-021-00820-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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4
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Jorgensen SCJ, Dersch-Mills D, Timberlake K, Stewart JJ, Gin A, Dresser LD, Dalton BR. AUCs and 123s: a critical appraisal of vancomycin therapeutic drug monitoring in paediatrics. J Antimicrob Chemother 2021; 76:2237-2251. [PMID: 33675656 DOI: 10.1093/jac/dkab048] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The revised vancomycin guidelines recommend implementing AUC24-based therapeutic drug monitoring (TDM) using Bayesian methods in both adults and paediatrics. The motivation for this change was accumulating evidence showing aggressive dosing to achieve high troughs, as recommended in the first guidelines for adults and extrapolated to paediatrics, is associated with increased nephrotoxicity without improving clinical outcomes. AUC24-based TDM requires substantial resources that may need to be diverted from other valuable interventions. It can therefore be justified only after certain assumptions are shown to be true: (i) there is a clear relationship between vancomycin efficacy and/or toxicity and the proposed therapeutic range; and (ii) maintaining exposure within the target range with AUC24-based TDM improves clinical outcomes and/or decreases toxicity. In this review, we critically appraise the scientific basis for these assumptions. We find studies evaluating the relationship between vancomycin AUC24/MIC and efficacy in adults and children do not offer strong support for the recommended lower limit of the proposed therapeutic range (i.e. AUC24/MIC ≥400). Nephrotoxicity in children increases in a stepwise manner along the vancomycin exposure continuum but it is unclear if one parameter (AUC24 versus trough) is a superior predictor. Overall, evidence in children suggests good-to-excellent correlation between AUC24 and trough. Most importantly, there is no convincing evidence that the method of vancomycin TDM has a causal role in improving efficacy or reducing toxicity. These findings question the need to transition to resource-intensive AUC24-based TDM over retaining trough-based TDM with lower targets to minimize nephrotoxicity in paediatrics.
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Affiliation(s)
| | | | - Kathryn Timberlake
- Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jackson J Stewart
- Pharmacy Services, University of Alberta Hospital, Edmonton, AB, Canada
| | - Alfred Gin
- Department of Pharmacy, Winnipeg Regional Health Authority, Winnipeg, MB, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Linda D Dresser
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Antimicrobial Stewardship Program, University Health Network, Toronto, ON, Canada
| | - Bruce R Dalton
- Pharmacy Services, Alberta Health Services, Calgary, AB, Canada
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5
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Rossato AM, Primon-Barros M, Dias CAG, d'Azevedo PA. Vancomycin MIC and agr dysfunction in invasive MRSA infections in southern Brazil. Braz J Microbiol 2020; 51:1819-1823. [PMID: 33074551 DOI: 10.1007/s42770-020-00384-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022] Open
Abstract
In methicillin-resistant Staphylococcus aureus (MRSA) treatment, the vancomycin minimum inhibitory concentration (MIC) increase, vancomycin heteroresistance (hVISA) presence, and accessory gene regulator (agr) dysfunction are predictors of vancomycin therapy failure. This study evaluated the association between vancomycin MIC (≥ 1.0 μg/mL) and agr dysfunction in invasive MRSA isolates. Vancomycin MIC, hVISA phenotype, agr group, and function were determined in 171 MRSA isolates obtained between 2014 and 2019 from hospitals in Porto Alegre, Brazil. All MRSA were susceptible to vancomycin; 16.4% of these had MIC ≥ 1.0 μg/mL. Seventeen MRSA isolates expressed the hVISA phenotype; 35.3% of them had MIC of 1.5 μg/mL. agr groups I (40.9%) and II (47.1%) were the most found groups for MRSA and hVISA isolates, respectively. The proportion of MRSA with vancomycin MIC ≥ 1.0 μg/mL in agr group II was significantly higher than in agr groups I and III (p = 0.002). agr dysfunction was observed in 4.7% (8/171) of MRSA, especially those with vancomycin MIC ≥ 1.0 μg/mL (p < 0.001). In addition, six isolates (35.3%; 6/17) with hVISA phenotype presented agr dysfunction, which was significantly higher than that in non-hVISA phenotype (p < 0.001). In conclusion, agr dysfunction in MRSA is associated with vancomycin MIC ≥ 1.0 μg/mL and hVISA phenotype, which suggests that agr dysfunction might confer potential advantages on MRSA to survive in invasive infections.
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Affiliation(s)
- Adriana Medianeira Rossato
- Basic Health Department, Postgraduate Program in Health Sciences of Porto Alegre (PPGCS), Federal University of Health Science of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
| | - Muriel Primon-Barros
- Basic Health Department, Postgraduate Program in Health Sciences of Porto Alegre (PPGCS), Federal University of Health Science of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Cícero Armídio Gomes Dias
- Basic Health Department, Postgraduate Program in Health Sciences of Porto Alegre (PPGCS), Federal University of Health Science of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Pedro Alves d'Azevedo
- Basic Health Department, Postgraduate Program in Health Sciences of Porto Alegre (PPGCS), Federal University of Health Science of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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6
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Shariati A, Dadashi M, Moghadam MT, van Belkum A, Yaslianifard S, Darban-Sarokhalil D. Global prevalence and distribution of vancomycin resistant, vancomycin intermediate and heterogeneously vancomycin intermediate Staphylococcus aureus clinical isolates: a systematic review and meta-analysis. Sci Rep 2020; 10:12689. [PMID: 32728110 PMCID: PMC7391782 DOI: 10.1038/s41598-020-69058-z] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/15/2020] [Indexed: 12/22/2022] Open
Abstract
Vancomycin-resistant Staphylococcus aureus (VRSA), Vancomycin-intermediate S. aureus (VISA) and heterogeneous VISA (hVISA) are subject to vancomycin treatment failure. The aim of the present study was to determine their precise prevalence and investigate prevalence variability depending on different years and locations. Several international databases including Medline (PubMed), Embase and Web of Sciences were searched (data from 1997 to 2019) to identify studies that addressed the prevalence of VRSA, VISA and hVISA among human clinical isolates around the world. Subgroup analyses and meta-regression were conducted to indicate potential source of variation. Publication bias was assessed using Egger's test. Statistical analyses were conducted using STATA software (version 14.0). Data analysis showed that VRSA, VISA and hVISA isolates were reported in 23, 50 and 82 studies, with an overall prevalence of 1.5% among 5855 S. aureus isolates, 1.7% among 22,277 strains and 4.6% among 47,721 strains, respectively. The overall prevalence of VRSA, VISA, and hVISA before 2010 was 1.2%, 1.2%, and 4%, respectively, while their prevalence after this year has reached 2.4%, 4.3%, and 5.3%. The results of this study showed that the frequency of VRSA, VISA and hVISA after 2010 represent a 2.0, 3.6 and 1.3-fold increase over prior years. In a subgroup analysis of different strain origins, the highest frequency of VRSA (3.6%) and hVISA (5.2%) was encountered in the USA while VISA (2.1%) was more prevalent in Asia. Meta-regression analysis showed significant increasing of VISA prevalence in recent years (p value ≤ 0.05). Based on the results of case reports (which were not included in the calculations mentioned above), the numbers of VRSA, VISA and hVISA isolates were 12, 24 and 14, respectively, among different continents. Since the prevalence of VRSA, VISA and hVISA has been increasing in recent years (especially in the Asian and American continents), rigorous monitoring of vancomycin treatment, it's the therapeutic response and the definition of appropriate control guidelines depending on geographical regions is highly recommended and essential to prevent the further spread of vancomycin-resistant S. aureus.
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Affiliation(s)
- Aref Shariati
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
- Non Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| | - Majid Taati Moghadam
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Alex van Belkum
- Open Innovation and Partnerships, Route de Port Michaud, 38390, La Balme Les Grottes, France
| | - Somayeh Yaslianifard
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Davood Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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7
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Ozmen Capin BB, Tekeli A, Karahan ZC. Evaluation of the Presence and Characterization of Vancomycin-Intermediate and Heterogeneous Vancomycin-Intermediate Level Resistance Among Bloodstream Isolates of Methicillin-Resistant Staphylococcus aureus. Microb Drug Resist 2020; 26:238-244. [PMID: 31545160 DOI: 10.1089/mdr.2019.0178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: Heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) could be misinterpreted as "susceptible" with routine susceptibility testing procedures, and the subpopulations with reduced susceptibility to glycopeptides can lead to therapeutic failure. The aim of this study was to evaluate the presence of VISA and hVISA strains among stocked bloodstream methicillin-resistant S. aureus (MRSA) isolates of 14 years. Materials and Methods: A total of 127 nonduplicate MRSA strains isolated from blood cultures between 2001 and 2014 were investigated. Glycopeptide minimum inhibitory concentration values were detected by microbroth dilution method. Susceptibilities to other antimicrobials were determined by the disk diffusion method and interpreted according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Macrogradient test (MGT) and modified population analysis profile-area under the curve (modified PAP-AUC) methods were used to detect VISA and hVISA. Staphylococcal Cassette Chromosome mec (SCCmec), agr, and toxin gene typing were done by polymerase chain reaction. Genetic relatedness of the strains were evaluated by pulsed-field gel electrophoresis (PFGE). Results: All isolates were susceptible to glycopeptides, linezolid, and quinupristin-dalfopristin. All were resistant to tetracycline, 96% were resistant to aminoglycosides, fluoroquinolones, and rifampin. Only 58.3% of the isolates were susceptible to ceftaroline. Six isolates were suspected as hVISA by the MGT, but none could be confirmed by the modified PAP-AUC analysis. All isolates carried type-III SCCmec, sea was the most prevalent (96.9%) enterotoxin gene and agr group I locus was predominant (93.7%). PFGE analysis revealed four main and four unique patterns. Conclusion: No hVISA or VISA were detected. The resistance rate to ceftaroline seems remarkable due to its recent entry into the market in Turkey.
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Affiliation(s)
- Busra Betul Ozmen Capin
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alper Tekeli
- Department of Medical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Ceren Karahan
- Department of Medical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
- Central Microbiology Laboratory, Ibn-i Sina Hospital, Ankara, Turkey
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8
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Strazzulla A, Postorino MC, Purcarea A, Chakvetadze C, de Farcy de Pontfarcy A, Tebano G, Pitsch A, Vong L, Jochmans S, Vinsonneau C, Monchi M, Diamantis S. Trimetoprim-sulfametoxazole in ventilator-associated pneumonia: a cohort study. Eur J Clin Microbiol Infect Dis 2019; 38:2163-2169. [PMID: 31372907 DOI: 10.1007/s10096-019-03656-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/22/2019] [Indexed: 01/22/2023]
Abstract
To evaluate the effectiveness of trimetoprim-sulfametoxazole (TMP-SMX) for treatment of ventilator-associated pneumonia (VAP). A retrospective cohort study including patients with VAP from 2011 to 2017. Two groups were analysed: TMP-SMX group, including patients who had received TMP-SMX (as first-line and as de-escalation), and No-TMP-SMX group, including patients who had not received TMP-SMX treatment. Primary clinical outcome was mortality at 30 days from starting the antibiotic treatment (T30). Secondary outcomes were mortality at end of treatment (EoT), day survival at T30, and acquisition of multidrug-resistant bacteria during hospitalization in intensive care unit. Eighty cases of VAP were included and devised into two groups: No-TMP-SMX (31/80; 39%) and TMP-SMX (49/80; 61%). Univariate analysis showed no significant differences were found when the TMP-SMX group was compared with the No-TMP-SMX group, except for frequency of male gender (p = 0.025). No significant statistical correlations between mortality at T30 and individual factors were detected by the multivariate model. No cases of either severe allergy or Clostridium difficile disease were reported in the TMP-SMX and No-TMP-SMX groups. TMP-SMX treatment was not associated with higher mortality at EoT and T30 in comparison with the No-TMP-SMX group. TMP-SMX had a good safety profile, in terms of ecology (acquisition of MDR bacteria and Clostridium difficile disease) and clinical management (no allergy events).
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Affiliation(s)
- Alessio Strazzulla
- Infectious Diseases Unit, Centre Hospitalier Sud Ile de France, Melun, France.
| | | | - Anastasia Purcarea
- Intensive Care Unit, Centre Hospitalier Sud Ile de France, Melun, France
| | | | | | - Gianpiero Tebano
- Infectious Diseases Unit, Centre Hospitalier Sud Ile de France, Melun, France
| | - Aurelia Pitsch
- Medical Biology Laboratory, Centre Hospitalier Sud Ile de France, Melun, France
| | - Lyvan Vong
- Intensive Care Unit, Centre Hospitalier Sud Ile de France, Melun, France
| | - Sebastien Jochmans
- Intensive Care Unit, Centre Hospitalier Sud Ile de France, Melun, France
| | | | - Mehran Monchi
- Intensive Care Unit, Centre Hospitalier Sud Ile de France, Melun, France
| | - Sylvain Diamantis
- Infectious Diseases Unit, Centre Hospitalier Sud Ile de France, Melun, France
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9
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Zhu Q, Yue Y, Zhu L, Cui J, Zhu M, Chen L, Yang Z, Liang Z. Epidemiology and microbiology of Gram-positive bloodstream infections in a tertiary-care hospital in Beijing, China: a 6-year retrospective study. Antimicrob Resist Infect Control 2018; 7:107. [PMID: 30202520 PMCID: PMC6122739 DOI: 10.1186/s13756-018-0398-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/21/2018] [Indexed: 01/23/2023] Open
Abstract
Background Gram-positive bacterial bloodstream infections (BSIs) are serious diseases associated with high morbidity and mortality. The following study examines the incidence, clinical characteristics and microbiological features, drug resistance situations and mortality associated with Gram-positive BSIs at a large Chinese tertiary-care hospital in Beijing, China. Methods A retrospective cohort study of patients with Gram-positive BSIs was performed between January 1, 2011, and June 31, 2017, at the Chinese People’s Liberation Army General Hospital. The patients’ data were collected and included in the reviewing electronic medical records. Results A total of 6887 episodes of Gram-positive BSIs occurred among 4275 patients over 6 years, and there were 3438 significant BSI episodes 69% of these cases were healthcare-associated, while 31% were community-associated. The overall incidence of Gram-positive BSIs fluctuated from 7.26 to 4.63 episodes per 1000 admissions over 6 years. Malignancy was the most common comorbidity and indwelling central intravenous catheter was the most common predisposing factor for BSI. Staphylococci were the major pathogen (65.5%), followed by Enterococcus spp:(17.5%), Streptococcus spp.(7.1%) and other bacterial pathogens (9.9%). The resistance rates of Staphylococci and E.faecium to penicillins were more than 90%. the vancomycin-resistant isolates were E. faecium (4.1%) and staphylococcus epidermidis (0.13%); and only E.faecalis and E.faecium showed resistance to linezolid (3.8% and 3.1%). Between 2011 and 2017, the overall mortality of Gram-positive BSIs decreased from 6.27 to 4.75% (X2 = 0.912, p = 0.892). Neverthess, the mortality in the ICU decreased from 60.46 to 47.82%, while in the general ward it increased from 39.54 to 52.18%. Conclusions The morbidity and mortality of Gram-positive BSIs have showed downward trends. Vancomycin and linezolid are still consider the best treatment for patients with Gram-positive BSIs.
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Affiliation(s)
- Qiang Zhu
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Yan Yue
- 3The postgraduate department, Chinese PLA General Hospital, Beijing, 100853 China
| | - Lichen Zhu
- Department of Respiratory Medicine, Affiliated Hospital of Nantong Third People's Hospital, Qingnian Central Street No. 99, Jiangsu Province, 226000 China
| | - Jiewei Cui
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Minghui Zhu
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Liangan Chen
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Zhen Yang
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Zhixin Liang
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
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10
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Asakura K, Azechi T, Sasano H, Matsui H, Hanaki H, Miyazaki M, Takata T, Sekine M, Takaku T, Ochiai T, Komatsu N, Shibayama K, Katayama Y, Yahara K. Rapid and easy detection of low-level resistance to vancomycin in methicillin-resistant Staphylococcus aureus by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. PLoS One 2018. [PMID: 29522576 PMCID: PMC5844673 DOI: 10.1371/journal.pone.0194212] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Vancomycin-intermediately resistant Staphylococcus aureus (VISA) and heterogeneous VISA (hVISA) are associated with treatment failure. hVISA contains only a subpopulation of cells with increased minimal inhibitory concentrations, and its detection is problematic because it is classified as vancomycin-susceptible by standard susceptibility testing and the gold-standard method for its detection is impractical in clinical microbiology laboratories. Recently, a research group developed a machine-learning classifier to distinguish VISA and hVISA from vancomycin-susceptible S. aureus (VSSA) according to matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) data. Nonetheless, the sensitivity of hVISA classification was found to be 76%, and the program was not completely automated with a graphical user interface. Here, we developed a more accurate machine-learning classifier for discrimination of hVISA from VSSA and VISA among MRSA isolates in Japanese hospitals by means of MALDI-TOF MS data. The classifier showed 99% sensitivity of hVISA classification. Furthermore, we clarified the procedures for preparing samples and obtaining MALDI-TOF MS data and developed all-in-one software, hVISA Classifier, with a graphical user interface that automates the classification and is easy for medical workers to use; it is publicly available at https://github.com/bioprojects/hVISAclassifier. This system is useful and practical for screening MRSA isolates for the hVISA phenotype in clinical microbiology laboratories and thus should improve treatment of MRSA infections.
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Affiliation(s)
- Kota Asakura
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Takuya Azechi
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Hiroshi Sasano
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Hidehito Matsui
- Infection Control Research Center, Kitasato Institute for Life Science, Kitasato University, Tokyo, Japan
| | - Hideaki Hanaki
- Infection Control Research Center, Kitasato Institute for Life Science, Kitasato University, Tokyo, Japan
| | - Motoyasu Miyazaki
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Tohru Takata
- Department of Infection Control, Fukuoka University Hospital, Fukuoka, Japan
| | - Miwa Sekine
- Department of Microbiology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Tomoiku Takaku
- Division of Hematology, Department of Internal Medicine, Juntendo University, Tokyo, Japan
| | - Tomonori Ochiai
- Division of Hematology, Department of Internal Medicine, Juntendo University, Tokyo, Japan
| | - Norio Komatsu
- Division of Hematology, Department of Internal Medicine, Juntendo University, Tokyo, Japan
| | - Keigo Shibayama
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuki Katayama
- Department of Microbiology, Faculty of Medicine, Juntendo University, Tokyo, Japan
- * E-mail: (KY); (YK)
| | - Koji Yahara
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
- * E-mail: (KY); (YK)
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11
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Velázquez-Guadarrama N, Olivares-Cervantes AL, Salinas E, Martínez L, Escorcia M, Oropeza R, Rosas I. Presence of environmental coagulase-positive staphylococci, their clonal relationship, resistance factors and ability to form biofilm. Rev Argent Microbiol 2017; 49:15-23. [DOI: 10.1016/j.ram.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 07/20/2016] [Accepted: 08/30/2016] [Indexed: 10/20/2022] Open
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12
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Adler A, Friedman ND, Marchaim D. Multidrug-Resistant Gram-Negative Bacilli: Infection Control Implications. Infect Dis Clin North Am 2016; 30:967-997. [PMID: 27660090 DOI: 10.1016/j.idc.2016.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Antimicrobial resistance is a common iatrogenic complication of both modern life and medical care. Certain multidrug resistant and extensively drug resistant Gram-negative organisms pose the biggest challenges to health care today, predominantly owing to a lack of therapeutic options. Containing the spread of these organisms is challenging, and in reality, the application of multiple control measures during an evolving outbreak makes it difficult to measure the relative impact of each measure. This article reviews the usefulness of various infection control measures in containing the spread of multidrug-resistant Gram-negative bacilli.
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Affiliation(s)
- Amos Adler
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Department of Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Dror Marchaim
- Department of Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
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13
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Najar-Peerayeh S, Mirzaee M, Behmanesh M. Molecular characterization of vancomycin-intermediate Staphylococcus aureus isolates from Tehran. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2016. [DOI: 10.1016/s2222-1808(16)61118-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Adams DJ, Eberly MD, Goudie A, Nylund CM. Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States. Hosp Pediatr 2016; 6:404-11. [PMID: 27250774 DOI: 10.1542/hpeds.2015-0196] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Vancomycin-resistant Enterococcus (VRE) is an emerging drug-resistant organism responsible for increasing numbers of nosocomial infections in adults. Few data are available on the epidemiology and impact of VRE infections in children. We hypothesized a significant increase in VRE infections among hospitalized children. Additionally, we predicted that VRE infection would be associated with certain comorbid conditions and increased duration and cost of hospitalization. METHODS A retrospective study of inpatient pediatric patients was performed using data on hospitalizations for VRE from the Healthcare Cost and Utilization Project Kids' Inpatient Database from 1997 to 2012. We used a multivariable logistic regression model to establish factors associated with VRE infection and a high-dimensional propensity score match to evaluate death, length of stay, and cost of hospitalization. RESULTS Hospitalizations for VRE infection showed an increasing trend, from 53 hospitalizations per million in 1997 to 120 in 2012 (P < .001). Conditions associated with VRE included Clostridium difficile infection and other diagnoses involving immunosuppression and significant antibiotic and health care exposure. Patients with VRE infection had a significantly longer length of stay (attributable difference [AD] 2.1 days, P < .001) and higher hospitalization costs (AD $8233, P = .004). VRE infection was not associated with an increased risk of death (odds ratio 1.03; 95% confidence interval 0.73-1.47). CONCLUSIONS VRE infections among hospitalized children are increasing at a substantial rate. This study demonstrates the significant impact of VRE on the health of pediatric patients and highlights the importance of strict adherence to existing infection control policies and VRE surveillance in certain high-risk pediatric populations.
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Affiliation(s)
- Daniel J Adams
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; and
| | - Matthew D Eberly
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; and
| | - Anthony Goudie
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Cade M Nylund
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; and
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Akova M. Epidemiology of antimicrobial resistance in bloodstream infections. Virulence 2016; 7:252-66. [PMID: 26984779 PMCID: PMC4871634 DOI: 10.1080/21505594.2016.1159366] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/17/2016] [Accepted: 02/23/2016] [Indexed: 12/14/2022] Open
Abstract
Antimicrobial resistance in bacterial pathogens is a worldwide challenge leading high morbidity and mortality in clinical settings. Multidrug resistant patterns in gram-positive and -negative bacteria have resulted in difficult-to-treat or even untreatable infections with conventional antimicrobials. Since the early identification of causative microorganisms and their antimicrobial susceptibility patterns in patients with bacteremia and other serious infections is lacking in many healthcare institutions, broad spectrum antibiotics are liberally and mostly unnecessarily used. Such practice has, in turn, caused dramatic increases in emerging resistance and when coupled with poor practice of infection control, resistant bacteria can easily be disseminated to the other patients and the environment. Thus, availability of updated epidemiological data on antimicrobial resistance in frequently encountered bacterial pathogens will be useful not only for deciding on empirical treatment strategies, but also devising an effective antimicrobial stewardship program in hospitals.
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Affiliation(s)
- Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
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Kim JW, Kang GS, Yoo JI, Kim HS, Lee YS, Yu JY, Lee KJ, Park C, Kim IH. Molecular Typing and Resistance Profiles of Vancomycin-IntermediateStaphylococcus aureusin Korea: Results from a National Surveillance Study, 2007-2013. ANNALS OF CLINICAL MICROBIOLOGY 2016. [DOI: 10.5145/acm.2016.19.4.88] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jung Wook Kim
- Division of Antimicrobial Resistance, Korea National Research Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Gi Su Kang
- Division of Antimicrobial Resistance, Korea National Research Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Jae Il Yoo
- Division of Antimicrobial Resistance, Korea National Research Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Hwa Su Kim
- Division of Antimicrobial Resistance, Korea National Research Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Yeong Seon Lee
- Division of Antimicrobial Resistance, Korea National Research Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Jae-Yon Yu
- Division of Antimicrobial Resistance, Korea National Research Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Kwang-Jun Lee
- Division of Antimicrobial Resistance, Korea National Research Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Chan Park
- Division of Antimicrobial Resistance, Korea National Research Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Il-Hwan Kim
- Division of Antimicrobial Resistance, Korea National Research Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea
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Susceptibility trends including emergence of linezolid resistance among coagulase-negative staphylococci and meticillin-resistant Staphylococcus aureus from invasive infections. Int J Antimicrob Agents 2015; 46:622-30. [DOI: 10.1016/j.ijantimicag.2015.07.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022]
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Molecular epidemiology of heteroresistant vancomycin-intermediate Staphylococcus aureus in Brazil. Braz J Infect Dis 2015; 19:466-72. [PMID: 26303003 PMCID: PMC9427604 DOI: 10.1016/j.bjid.2015.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/07/2015] [Accepted: 06/12/2015] [Indexed: 11/21/2022] Open
Abstract
To determine the epidemiological and molecular characteristics of 12 Staphylococcus aureus isolates presenting heteroresistance to vancomycin in laboratories of two cities in Santa Catarina, southern Brazil. Epidemiological data, including the city of isolation, health institution, and date of isolation were considered, as well as the associated clinical specimen. For molecular characterization, we analyzed the staphylococcal cassette chromosome types, the erm gene presence, and the genomic diversity of isolates using pulsed-field gel electrophoresis. The 12 isolates of S. aureus were previously confirmed as heteroresistance to vancomycin using the population analysis profile–area under curve. Regarding genetic variability, two clones were detected: the main one (clone A) composed of four isolates and the clones B, with two isolates. For clone A, two isolates presented identical band patterns and were related to the same hospital, with an interval of 57 days between their isolation. The other isolates of this clone showed no epidemiological link between them because they were isolated in different hospitals and had no temporal relationship. The other clone showed no detectable epidemiological relationship. The heteroresistance to vancomycin recovered in Santa Catarina State from 2009 to 2012 had, in general, heterogeneous genomic patterns based on pulsed-field gel electrophoresis results, which is in accordance with the fact that these isolates had little or no epidemiological relationship among them. Due to the characteristic phenotypic instability and often prolonged vancomycin therapy for selection, clonal spread is not as common as for other resistance mechanisms disseminated through horizontal gene transfer.
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Screening for Intermediately Vancomycin-Susceptible and Vancomycin-Heteroresistant Staphylococcus aureus by Use of Vancomycin-Supplemented Brain Heart Infusion Agar Biplates: Defining Growth Interpretation Criteria Based on Gold Standard Confirmation. J Clin Microbiol 2015; 53:3543-6. [PMID: 26311860 DOI: 10.1128/jcm.01620-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/22/2015] [Indexed: 01/23/2023] Open
Abstract
BHI agars supplemented with vancomycin 4 (BHI-V4) and 3 (BHI-V3) mg/liter have been proposed for screening vancomycin intermediately susceptible Staphylococcus aureus (VISA) and heteroresistant (hVISA) phenotypes, respectively, but growth interpretation criteria have not been established. We reviewed the growth results (CFU) during population analysis profile-area under the curve (PAP-AUC) of consecutive methicillin-resistant Staphylococcus aureus (MRSA) blood isolates, which were saved intermittently between 1996 and 2012. CFU counts on BHI-V4 and BHI-V3 plates were stratified according to PAP-AUC interpretive criteria: <0.90 (susceptible [S-MRSA]), 0.90 to 1.3 (hVISA), and >1.3 (VISA). CFU cutoffs that best predict VISA and hVISA were determined with the use of receiver operating characteristic (ROC) curves. Mu3, Mu50, and methicillin-susceptible S. aureus (MSSA) controls were included. We also prospectively evaluated manufacturer-made BHI-V3/BHI-V4 biplates for screening of 2010-2012 isolates. The PAP-AUC of 616 clinical samples was consistent with S-MRSA, hVISA, and VISA in 550 (89.3%), 48 (7.8%), and 18 (2.9%) instances, respectively. For VISA screening on BHI-V4, a cutoff of 2 CFU/droplet provided 100% sensitivity and 97.7% specificity. To distinguish VISA from hVISA, a cutoff of 16 CFU provided 83.3% sensitivity and 94.7% specificity; the specificity was lowered to 89.5% with a 12-CFU cutoff. For detecting hVISA/VISA on BHI-V3, a 2-CFU/droplet cutoff provided 98.5% sensitivity and 93.8% specificity. These results suggest that 2-CFU/droplet cutoffs on BHI-V4 and BHI-V3 best approximate VISA and hVISA gold standard confirmation, respectively, with minimal overlap in samples with borderline PAP-AUC. Simultaneous screening for VISA/hVISA on manufacturer-made BHI-V4/BHI-V3 biplates is easy to standardize and may reduce the requirement for PAP-AUC confirmation.
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Zhang S, Sun X, Chang W, Dai Y, Ma X. Systematic Review and Meta-Analysis of the Epidemiology of Vancomycin-Intermediate and Heterogeneous Vancomycin-Intermediate Staphylococcus aureus Isolates. PLoS One 2015; 10:e0136082. [PMID: 26287490 PMCID: PMC4546009 DOI: 10.1371/journal.pone.0136082] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/29/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Vancomycin-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. METHODS A 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. RESULTS The 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. CONCLUSION The 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.
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Affiliation(s)
- Shanshan Zhang
- School of Medicine, Shandong University, Ji’nan, 250061, PR China
| | - Xiaoxi Sun
- Department of Clinical Laboratory, Affiliated Provincial Hospital of Anhui Medical University, Hefei, 230001, PR China
| | - Wenjiao Chang
- Department of Clinical Laboratory, Affiliated Provincial Hospital of Anhui Medical University, Hefei, 230001, PR China
| | - Yuanyuan Dai
- Department of Clinical Laboratory, Affiliated Provincial Hospital of Anhui Medical University, Hefei, 230001, PR China
| | - Xiaoling Ma
- Department of Clinical Laboratory, Affiliated Provincial Hospital of Anhui Medical University, Hefei, 230001, PR China
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21
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Huang SH, Chen YC, Chuang YC, Chiu SK, Fung CP, Lu PL, Wang LS, Wu TL, Wang JT. Prevalence of vancomycin-intermediate Staphylococcus aureus (VISA) and heterogeneous VISA among methicillin-resistant S. aureus with high vancomycin minimal inhibitory concentrations in Taiwan: A multicenter surveillance study, 2012-2013. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 49:701-707. [PMID: 26320398 DOI: 10.1016/j.jmii.2015.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/12/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND/PURPOSE Intermediate-resistance and heteroresistance to vancomycin in methicillin-resistant Staphylococcus aureus (MRSA) is reported worldwide. A surveillance study in 2003 showed that the prevalence rates of vancomycin-intermediate S. aureus (VISA) and heterogeneous VISA (hVISA) in Taiwan were 0.2% and 0.7%, respectively. This study aimed to investigate the updated prevalence of VISA and hVISA in Taiwan. METHODS MRSA isolates from sterile sites with minimal inhibitory concentrations (MICs) of 1 μg/mL or more to vancomycin were collected from 15 participating hospitals in Taiwan. Enrolled MRSA isolates were submitted to antimicrobial susceptibility testing, staphylococcal cassette chromosome mec (SCCmec) element typing, and multilocus sequence typing. Isolates with vancomycin MIC of 1 μg/mL or 2 μg/mL were screened for vancomycin heterogeneous resistance by Etest glycopeptide-resistance detection (GRD). Those with positive GRD screening results were then analyzed by modified population analysis profiling-area under the curve method for confirmation of vancomycin heteroresistance. RESULTS Between 2012 and 2013, a total of 622 MRSA isolates from sterile sites with vancomycin MIC of 1 μg/mL or more were studied. The prevalence rates of hVISA and VISA among these isolates were 10.0% and 2.7%, respectively. The hVISA prevalence increased significantly compared to that in 2003. Compared with vancomycin-susceptible S. aureus, hVISA and VISA isolates were less susceptible to ciprofloxacin, clindamycin, daptomycin, gentamicin, rifampin, and trimethoprim/sulfamethoxazole, and are thus, more likely to have SCCmec II or III element. A twofold increase in either vancomycin or teicoplanin MIC doubled the probability of being hVISA. CONCLUSION Growing hVISA prevalence was highly suspected. Longitudinal surveillance of this phenomenon and monitoring of its clinical impact are necessary.
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Affiliation(s)
- Sung-Hsi Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yee-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yin-Ching Chuang
- Department of Medical Research, Chi Mei Medical Center, Tainan County, Taiwan
| | - Sheng-Kang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Phone Fung
- Section of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, National Yan-Ming University, Taipei, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Lih-Shinn Wang
- Department of Infectious Diseases, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Tsu-Lan Wu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Abstract
"Heteroresistance" describes a phenomenon where subpopulations of seemingly isogenic bacteria exhibit a range of susceptibilities to a particular antibiotic. Unfortunately, a lack of standard methods to determine heteroresistance has led to inappropriate use of this term. Heteroresistance has been recognized since at least 1947 and occurs in Gram-positive and Gram-negative bacteria. Its clinical relevance may be considerable, since more resistant subpopulations may be selected during antimicrobial therapy. However, the use of nonstandard methods to define heteroresistance, which are costly and involve considerable labor and resources, precludes evaluating the clinical magnitude and severity of this phenomenon. We review the available literature on antibiotic heteroresistance and propose recommendations for definitions and determination criteria for heteroresistant bacteria. This will help in assessing the global clinical impact of heteroresistance and developing uniform guidelines for improved therapeutic outcomes.
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O'Donoghue MM, Doddangoudar VC, Tsang DNC, Boost MV. Importance of early detection of vancomycin-resistant subpopulations in apparently susceptible meticillin-resistant Staphylococcus aureus clinical isolates. J Glob Antimicrob Resist 2015; 3:64-68. [PMID: 27873671 DOI: 10.1016/j.jgar.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/17/2014] [Accepted: 01/12/2015] [Indexed: 11/18/2022] Open
Abstract
This study aimed to investigate the presence of vancomycin-non-susceptible subpopulations in apparently susceptible meticillin-resistant Staphylococcus aureus (MRSA) and the ability of these isolates to develop into homogeneously resistant strains. Vancomycin MICs of 200 clinical MRSA isolates were determined using agar dilution (AD) and spiral gradient endpoint (SGE) technique. Isolates with an MIC≤2mg/L but displaying subpopulations with an MIC>2mg/L by SGE were re-tested by Etest and PAP-AUC and were incubated with 2mg/L vancomycin for 2 weeks. MIC testing was repeated weekly by AD, Etest and SGE to observe progression to non-susceptibility. A total of 17.5% and 16.0% of isolates were non-susceptible to vancomycin (MIC>2mg/L) by SGE and AD, respectively. Eight isolates (4%) displayed a resistant subpopulation; five met the definition of hVISA by PAP-AUC. The initial Etest MIC for these isolates was 2mg/L, but resistant subpopulations were observed in only three isolates on prolonged incubation. MICs of all eight isolates increased rapidly in the presence of vancomycin, reaching ≥3.0mg/L by Day 7 and ≥4mg/L after 14 days by all three methods. The prevalence of vancomycin-non-susceptible MRSA was high, and non-susceptibility developed rapidly in seemingly susceptible isolates with covert subpopulations. These were effectively detected by SGE. With increasing reports of vancomycin clinical failure, early detection of potentially non-susceptible isolates before or early in vancomycin therapy is essential to avoid further resistance development and poor clinical outcomes. SGE offers a novel and cost-effective technique for detection of potentially non-susceptible strains.
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Affiliation(s)
- M M O'Donoghue
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - V C Doddangoudar
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - D N C Tsang
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - M V Boost
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Singh A, Prasad KN, Misra R, Rahman M, Singh SK, Rai RP, Tripathi A, Srivastava JK. Increasing Trend of Heterogeneous Vancomycin Intermediate Staphylococcus aureus in a Tertiary Care Center of Northern India. Microb Drug Resist 2015; 21:545-50. [PMID: 26430942 DOI: 10.1089/mdr.2015.0004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Heterogeneous vancomycin intermediate Staphylococcus aureus (hVISA) strains are increasingly reported, and their association with vancomycin treatment failure is a well-known problem worldwide. A total of 500 clinical isolates of methicillin-resistant S. aureus were screened for hVISA by four different methods from May 2011 to May 2014. The number of strains screened for hVISA from May to April in 2011-2012, 2012-2013, and 2013-2014 were 198, 123, and 179, respectively. hVISA strains were studied by transmission electron microscopy (TEM) for cell wall thickness and also for their ability to form biofilm on a polystyrene microtiter plate. hVISA strains detected by four different methods-brain heart infusion agar with vancomycin with 4 mg/L/gradient plate/macro E-test/and glycopeptide resistance detection (GRD) E test-were as follows: 11.6%/10%/9%, and 9.5% in 2011-2012, 12.1%/9.7%/8.9%, and 10.5% in 2012-2013, and 13.9%/11.7%/11.1%, and 12.8% in 2013-2014, respectively. Population analysis profile-area under curve analysis confirmed hVISA in 4.5% (9/198), 6.5% (8/123), and 6.7% (12/179) in respective years; 24% (7/29) of hVISA isolates were nonsusceptible to daptomycin. TEM showed a significant increase in cell wall thickness of hVISA isolates (p<0.001) with a distinct reduction in their biofilm formation ability.
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Affiliation(s)
- Avinash Singh
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, Uttar Pradesh, India .,2 Amity Institute of Biotechnology, Amity University Uttar Pradesh , Lucknow, Uttar Pradesh, India
| | - Kashi Nath Prasad
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, Uttar Pradesh, India
| | - Richa Misra
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, Uttar Pradesh, India
| | - Mohibur Rahman
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, Uttar Pradesh, India
| | - Satyendra Kumar Singh
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, Uttar Pradesh, India
| | - Ravi Prakash Rai
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, Uttar Pradesh, India
| | - Aparna Tripathi
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, Uttar Pradesh, India
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Mirza HC, Sancak B, Gür D. The Prevalence of Vancomycin-Intermediate Staphylococcus aureus and Heterogeneous VISA Among Methicillin-Resistant Strains Isolated from Pediatric Population in a Turkish University Hospital. Microb Drug Resist 2015; 21:537-44. [PMID: 25919019 DOI: 10.1089/mdr.2015.0048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
There are limited data regarding the prevalence of vancomycin-intermediate Staphylococcus aureus (VISA)/heterogeneous VISA (hVISA) among pediatric population. Our objective was to determine the distribution of vancomycin and daptomycin minimum inhibitory concentrations (MICs) and explore the phenomenon of vancomycin MIC creep and the VISA/hVISA prevalence among the methicillin-resistant Staphylococcus aureus (MRSA) strains belonging to pediatric population by population analysis profile-area under the curve (PAP-AUC) and Etest macromethod. Vancomycin and daptomycin susceptibilities of 94 pediatric isolates of MRSA were tested by broth microdilution (BMD) and Etest methods. To determine the prevalence of VISA/hVISA, Etest macromethod and PAP-AUC was performed on all isolates. All isolates were susceptible to vancomycin and daptomycin by both BMD and Etest methods. Twenty-eight (29.8%) isolates had vancomycin MICs of 2 μg/ml by BMD. No increase in vancomycin MICs was observed over time. There were no VISA among 94 MRSA tested but 20 (21.3%) hVISA isolates were identified by PAP-AUC. Results of Etest macromethod were compared to PAP-AUC. Etest macromethod was 60.0% sensitive and 90.5% specific. The hVISA isolates represented 53.6% of isolates with vancomycin MICs of 2 μg/ml. Also, 75% of hVISA isolates had vancomycin MICs of 2 μg/ml. To our knowledge, this is the first study investigating the prevalence of VISA/hVISA among MRSA isolated from pediatric patients by PAP-AUC method. Based on our findings, MRSA isolates, which have vancomycin MIC of 2 μg/ml can be investigated for the presence of hVISA. In this study, daptomycin showed potent activity against all isolates and may represent a therapeutic option for MRSA infections.
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Affiliation(s)
- Hasan Cenk Mirza
- 1 Department of Medical Microbiology, Merzifon State Hospital , Amasya, Turkey
| | - Banu Sancak
- 2 Department of Medical Microbiology, Hacettepe University Medical School , Ankara, Turkey
| | - Deniz Gür
- 2 Department of Medical Microbiology, Hacettepe University Medical School , Ankara, Turkey
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26
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Gomes DM, Ward KE, LaPlante KL. Clinical implications of vancomycin heteroresistant and intermediately susceptible Staphylococcus aureus. Pharmacotherapy 2015; 35:424-32. [PMID: 25884530 DOI: 10.1002/phar.1577] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Staphylococcus aureus (S. aureus) has proven to be a major pathogen with the emergence of methicillin-resistant S. aureus (MRSA) infections and recently with heteroresistant vancomycin-intermediate S. aureus (hVISA) and vancomycin-intermediate S. aureus (VISA) infections. Although vancomycin is traditionally a first-line and relatively effective antibiotic, its continued use is under question because reports of heteroresistance in S. aureus isolates are increasing. Both hVISA and VISA infections are associated with complicated clinical courses and treatment failures. The prevalence, mechanism of resistance, clinical significance, and laboratory detection of hVISA and VISA infections are not conclusive, making it difficult to apply research findings to clinical situations. We provide an evidence-based review of S. aureus isolates expressing heterogenic and reduced susceptibility to vancomycin.
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Affiliation(s)
- Diane M Gomes
- Department of Pharmacy Practice, University of Rhode Island, Kingston, Rhode Island; Veterans Affairs Medical Center, Providence, Rhode Island
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Maor Y, Belausov N, Ben-David D, Smollan G, Keller N, Rahav G. hVISA and MRSA endocarditis: an 8-year experience in a tertiary care centre. Clin Microbiol Infect 2014; 20:O730-6. [DOI: 10.1111/1469-0691.12498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 12/03/2013] [Accepted: 12/09/2013] [Indexed: 12/25/2022]
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Abstract
Infective endocarditis (IE) continues to present a large burden to the health-care system. Staphylococcus aureus, the leading pathogen associated with the disease, has always proven difficult to treat. Increasing numbers of S. aureus isolates are demonstrating reduced susceptibility to vancomycin, and therapeutic options are limited. Daptomycin is frequently employed when vancomycin therapy proves unsuccessful or when vancomycin minimum inhibitory concentration (MIC) values rise above 1 mg/L. Currently, daptomycin is FDA-approved at a dose of 6 mg/kg/day for the treatment of S. aureus bacteremia and associated right-sided endocarditis. However, numerous in vitro and clinical studies suggest that daptomycin doses up to 12 mg/kg/day may provide improved efficacy and resistance prevention. Additionally, high-dose daptomycin has demonstrated excellent safety. Together, these data suggest a role for high-dose daptomycin in staphylococcal IE patients who are severely ill, previously failed therapy with vancomycin, or possess a S. aureus isolate with an elevated vancomycin MIC.
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Stryjewski ME, Corey GR. Methicillin-resistant Staphylococcus aureus: an evolving pathogen. Clin Infect Dis 2014; 58 Suppl 1:S10-9. [PMID: 24343827 DOI: 10.1093/cid/cit613] [Citation(s) in RCA: 223] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The horizontal transmission of methicillin resistance to Staphylococcus aureus (MRSA) in hospital and community settings, and growing prevalence of these strains, presents a significant clinical challenge to the management of serious infections worldwide. While infection control initiatives have stemmed the rising prevalence, MRSA remains a significant pathogen. More recently, evidence that MRSA is becoming resistant to glycopeptides and newer therapies raises concern about the use of these therapies in clinical practice. Vancomycin resistance has become evident in select clinical settings through rising MICs, growing awareness of heteroresistance, and emergence of intermediate-resistant and fully resistant strains. While resistance to linezolid and daptomycin remains low overall, point mutations leading to resistance have been described for linezolid, and horizontal transmission of cfr-mediated resistance to linezolid has been reported in clinical isolates. These resistance trends for newer therapies highlight the ongoing need for new and more potent antimicrobial therapies.
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Affiliation(s)
- Martin E Stryjewski
- Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Buenos Aires, Argentina
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Hanaki H, Cui L, Ikeda-Dantsuji Y, Nakae T, Honda J, Yanagihara K, Takesue Y, Matsumoto T, Sunakawa K, Kaku M, Tomono K, Fukuchi K, Kusachi S, Mikamo H, Takata T, Otsuka Y, Nagura O, Fujitani S, Aoki Y, Yamaguchi Y, Tateda K, Kadota J, Kohno S, Niki Y. Antibiotic susceptibility survey of blood-borne MRSA isolates in Japan from 2008 through 2011. J Infect Chemother 2014; 20:527-34. [PMID: 25066429 DOI: 10.1016/j.jiac.2014.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 01/27/2014] [Accepted: 06/26/2014] [Indexed: 11/17/2022]
Abstract
We conducted an antibiotic susceptibility survey of 830 blood-borne methicillin resistant Staphylococcus aureus collected from nationwide hospitals in Japan over a three-year period from January 2008 through May 2011. Antibiotic susceptibility was judged according to the criteria recommended by the Clinical Laboratory Standard Institute. Over 99% of the MRSA showed to be susceptible to teicoplanin, linezolid, sulfamethoxazole/trimethoprim and vancomycin, and over 97% of them were susceptible to daptomycin, arbekacin and rifampin. The majority of the MRSA strains showed resistant to minocycline, meropenem, imipenem, clindamycin, ciprofloxacin, cefoxitin, and oxacillin in the rates of 56.6, 72.9, 73.7, 78.7, 89.0, 99.5, and 99.9%, respectively. Among the MRSA strains, 72 showed reduced susceptibility to vancomycin, including 8 strains (0.96%) of vancomycin-intermediate S. aureus (VISA), 54 (6.51%) of heterogeneous vancomycin-intermediate S. aureus (hVISA), and 55 (5.63%) of β-lactam antibiotics-induced vancomycin resistant S. aureus (BIVR). Unexpectedly, among the 54 hVISA and 55 BIVR, 45 isolates (83.3% and 81.8%, respectively) showed both hVISA and BIVR phenotypes. A new trend of vancomycin resistance found in this study was that VISA strains were still prevalent among the bacteremic specimens. The high rates of the hVISA/BIVR two-phenotypic vancomycin resistance, and the prevalence of VISA in the bloodborne MRSA call attention in the MRSA epidemiology in Japan.
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Affiliation(s)
- Hideaki Hanaki
- Research Center for Infections and Antimicrobials, Kitasato Institute for Life Science, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-864, Japan.
| | - Longzhu Cui
- Research Center for Infections and Antimicrobials, Kitasato Institute for Life Science, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-864, Japan
| | - Yurika Ikeda-Dantsuji
- Research Center for Infections and Antimicrobials, Kitasato Institute for Life Science, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-864, Japan
| | - Taiji Nakae
- Research Center for Infections and Antimicrobials, Kitasato Institute for Life Science, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-864, Japan
| | - Junichi Honda
- Department of Infection Control, St Mary's Hospital, Fukuoka, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan
| | | | - Keisuke Sunakawa
- Graduate School of Infection Control Sciences, Kitasato University, Tokyo, Japan
| | - Mitsuo Kaku
- Central Clinical Laboratory, Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazunori Tomono
- Department of Clinical Infectious Disease, Osaka University School of Medicine, Osaka, Japan
| | - Kunihiko Fukuchi
- Department of Laboratory Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shinya Kusachi
- Faculty of Medicine, School of Medicine, 3rd Dept. of Surg. Toho Univ. School of Med., Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Tohru Takata
- Department of Infection Control, Fukuoka University Hospital, Fukuoka, Japan
| | - Yoshihito Otsuka
- Department of Laboratory Medicine, Kameda Medical Center, Chiba, Japan
| | - Osanori Nagura
- Department of Laboratory Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | | | - Yosuke Aoki
- Department of International Medicine, Division of Infectious Diseases, Faculty of Medicine, Saga University, Japan
| | - Yoshio Yamaguchi
- Department of Clinical Research, National Hospital Organization, Tochigi Medical Center, Tochigi, Japan
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo 143-8540, Japan
| | - Junichi Kadota
- Internal Medicine 2, Faculty of Medicine, Oita University, Idaigaoka 1-1, Hasama-machi, Yufu 879-5593, Japan
| | - Shigeru Kohno
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Yoshihito Niki
- Department of Clinical Infectious Diseases, Showa University School of Medicine, Tokyo, Japan
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Figueiredo AMS, Ferreira FA. The multifaceted resources and microevolution of the successful human and animal pathogen methicillin-resistant Staphylococcus aureus. Mem Inst Oswaldo Cruz 2014; 109:265-78. [PMID: 24789555 PMCID: PMC4131778 DOI: 10.1590/0074-0276140016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/12/2014] [Indexed: 11/22/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important bacterial pathogens based on its incidence and the severity of its associated infections. In addition, severe MRSA infections can occur in hospitalised patients or healthy individuals from the community. Studies have shown the infiltration of MRSA isolates of community origin into hospitals and variants of hospital-associated MRSA have caused infections in the community. These rapid epidemiological changes represent a challenge for the molecular characterisation of such bacteria as a hospital or community-acquired pathogen. To efficiently control the spread of MRSA, it is important to promptly detect the mecA gene, which is the determinant of methicillin resistance, using a polymerase chain reaction-based test or other rapidly and accurate methods that detect the mecA product penicillin-binding protein (PBP)2a or PBP2'. The recent emergence of MRSA isolates that harbour a mecA allotype, i.e., the mecC gene, infecting animals and humans has raised an additional and significant issue regarding MRSA laboratory detection. Antimicrobial drugs for MRSA therapy are becoming depleted and vancomycin is still the main choice in many cases. In this review, we present an overview of MRSA infections in community and healthcare settings with focus on recent changes in the global epidemiology, with special reference to the MRSA picture in Brazil.
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Affiliation(s)
- Agnes Marie Sá Figueiredo
- Departamento de Microbiologia Médica , Instituto de Microbiologia Paulo de
Góes , Universidade Federal do Rio de Janeiro , Rio de Janeiro , RJ ,
Brasil
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Edwards B, Andini R, Esposito S, Grossi P, Lew D, Mazzei T, Novelli A, Soriano A, Gould IM. Treatment options for methicillin-resistant Staphylococcus aureus (MRSA) infection: Where are we now? J Glob Antimicrob Resist 2014; 2:133-140. [PMID: 27873719 DOI: 10.1016/j.jgar.2014.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 01/05/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infection continues to be a substantial global problem with significant associated morbidity and mortality. This review summarises the discussions that took place at the 4th MRSA Consensus Conference in relation to the current treatment options for serious MRSA infections and how to optimise whichever therapy is embarked upon. It highlights the many challenges faced by both the laboratory and clinicians in the diagnosis and treatment of MRSA infections.
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Affiliation(s)
- B Edwards
- Medical Microbiology Department, Royal Infirmary of Edinburgh, 51 Little France Crescent, Dalkeith Road, Edinburgh EH16 4SA, UK.
| | - R Andini
- Second University of Naples, UOC Transplant and Infectious Disease Medicine, AORN Monaldi, Naples, Italy
| | - S Esposito
- Department of Medicine, University of Salerno, Salerno, Italy
| | - P Grossi
- Department of Surgical and Morphological Studies, University of Unisubria, Varese, Italy
| | - D Lew
- Chief Infectious Diseases Division, Chief Department of Specialties of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - T Mazzei
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Firenze, Firenze, Italy
| | - A Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Firenze, Firenze, Italy
| | - A Soriano
- Department of Infectious Diseases, IDIBAPS, Hospital Clinic of Barcelona, Spain
| | - I M Gould
- Medical Microbiology Department, Aberdeen Royal Infirmary, Aberdeen, UK
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Alam MT, Petit RA, Crispell EK, Thornton TA, Conneely KN, Jiang Y, Satola SW, Read TD. Dissecting vancomycin-intermediate resistance in staphylococcus aureus using genome-wide association. Genome Biol Evol 2014; 6:1174-85. [PMID: 24787619 PMCID: PMC4040999 DOI: 10.1093/gbe/evu092] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Vancomycin-intermediate Staphylococcus aureus (VISA) is currently defined as having minimal inhibitory concentration (MIC) of 4–8 µg/ml. VISA evolves through changes in multiple genetic loci with at least 16 candidate genes identified in clinical and in vitro-selected VISA strains. We report a whole-genome comparative analysis of 49 vancomycin-sensitive S. aureus and 26 VISA strains. Resistance to vancomycin was determined by broth microdilution, Etest, and population analysis profile-area under the curve (PAP-AUC). Genome-wide association studies (GWAS) of 55,977 single-nucleotide polymorphisms identified in one or more strains found one highly significant association (P = 8.78E-08) between a nonsynonymous mutation at codon 481 (H481) of the rpoB gene and increased vancomycin MIC. Additionally, we used a database of public S. aureus genome sequences to identify rare mutations in candidate genes associated with VISA. On the basis of these data, we proposed a preliminary model called ECM+RMCG for the VISA phenotype as a benchmark for future efforts. The model predicted VISA based on the presence of a rare mutation in a set of candidate genes (walKR, vraSR, graSR, and agrA) and/or three previously experimentally verified mutations (including the rpoB H481 locus) with an accuracy of 81% and a sensitivity of 73%. Further, the level of resistance measured by both Etest and PAP-AUC regressed positively with the number of mutations present in a strain. This study demonstrated 1) the power of GWAS for identifying common genetic variants associated with antibiotic resistance in bacteria and 2) that rare mutations in candidate gene, identified using large genomic data sets, can also be associated with resistance phenotypes.
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Affiliation(s)
- Md Tauqeer Alam
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
| | - Robert A Petit
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine
| | - Emily K Crispell
- Division of Infectious Diseases, Department of Medicine, Emory University School of MedicineAtlanta Veterans Affairs Medical Center
| | | | - Karen N Conneely
- Department of Human Genetics, Emory University School of Medicine
| | - Yunxuan Jiang
- Department of Human Genetics, Emory University School of MedicineDepartment of Biostatistics and Bioinformatics, Emory University School of Public Health
| | - Sarah W Satola
- Division of Infectious Diseases, Department of Medicine, Emory University School of MedicineAtlanta Veterans Affairs Medical Center
| | - Timothy D Read
- Division of Infectious Diseases, Department of Medicine, Emory University School of MedicineDepartment of Human Genetics, Emory University School of Medicine
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Richter SS, Diekema DJ, Heilmann KP, Dohrn CL, Crispell EK, Riahi F, McDanel JS, Satola SW, Doern GV. Activities of vancomycin, ceftaroline, and mupirocin against Staphylococcus aureus isolates collected in a 2011 national surveillance study in the United States. Antimicrob Agents Chemother 2013; 58:740-5. [PMID: 24247138 PMCID: PMC3910823 DOI: 10.1128/aac.01915-13] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 11/10/2013] [Indexed: 01/23/2023] Open
Abstract
Forty-two medical centers from throughout the United States participating in a longitudinal surveillance program were asked to submit 100 consecutive Staphylococcus aureus isolates during July to December 2011. Susceptibility testing using CLSI broth microdilution and mecA detection by PCR analysis was performed on the 4,131 isolates collected. Methods employing Etest glycopeptide resistance detection (GRD; bioMérieux) and brain heart infusion agar containing 4 μg/ml vancomycin (BHIV) were used to screen methicillin-resistant S. aureus (MRSA) isolates for heterogeneous intermediate-level resistance to vancomycin (hVISA). Isolates with positive hVISA screen results were confirmed by population analysis profiling-area under the curve (PAP-AUC) determinations. The genetic relatedness of hVISA, ceftaroline-nonsusceptible, or high-level (HL) mupirocin resistance MRSA isolates was assessed by pulsed-field gel electrophoresis (PFGE). Among 2,093 MRSA isolates, the hVISA screen results were positive with 47 isolates by Etest GRD and 30 isolates by BHIV agar screen. Twenty-five of the GRD- or BHIV screen-positive isolates were confirmed as hVISA by PAP-AUC testing. Results of the current study were compared to results obtained from prior surveillance performed in 2009. The prevalence of hVISA among MRSA isolates was higher in 2011 than in 2009 (1.2% versus 0.4%, P = 0.003), especially for isolates with a vancomycin MIC of 2 (45.4% versus 14.3%, P = 0.01). The overall rate of ceftaroline susceptibility in the current study was 99.4% (one hVISA isolate had an intermediate ceftaroline MIC). HL mupirocin resistance increased from 2.2% in 2009 to 3.2% in 2011 (P = 0.006). Although overall rates of hVISA and HL mupirocin resistance are low, they have increased since 2009.
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Affiliation(s)
| | | | | | - Cassie L. Dohrn
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Fathollah Riahi
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | | | - Gary V. Doern
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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β-Lactams enhance vancomycin activity against methicillin-resistant Staphylococcus aureus bacteremia compared to vancomycin alone. Antimicrob Agents Chemother 2013; 58:102-9. [PMID: 24145519 DOI: 10.1128/aac.01204-13] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Vancomycin (VAN) is often used to treat methicillin-resistant Staphylococcus aureus (MRSA) bacteremia despite a high incidence of microbiological failure. Recent in vitro analyses of β-lactams in combination with VAN demonstrated synergistic activity against MRSA. The goal of this study was to examine the impact of combination therapy with VAN and a β-lactam (Combo) on the microbiological eradication of MRSA bacteremia compared to VAN alone. This was a retrospective cohort study of patients with MRSA bacteremia who received Combo therapy or VAN alone. Microbiological eradication of MRSA, defined as a negative blood culture obtained after initiation of therapy, was used to evaluate the efficacy of each regimen. A total of 80 patients were included: 50 patients in the Combo group and 30 patients in the VAN-alone group. Microbiological eradication was achieved in 48 patients (96%) in the Combo group compared to 24 patients (80%) in the VAN-alone group (P = 0.021). In a multivariable model, the Combo treatment had a higher likelihood of achieving microbiological eradication (adjusted odds ratio, 11.24; 95% confidence interval, 1.7 to 144.3; P = 0.01). In patients with infective endocarditis (n = 22), 11/11 (100%) who received Combo therapy achieved microbiological eradication compared to 9/11 (81.8%) treated with VAN alone, but the difference was not statistically significant (P = 0.20). Patients with MRSA bacteremia who received Combo therapy were more likely to experience microbiological eradication of MRSA than patients who received VAN alone.
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Abstract
New antimicrobial agents are always needed to counteract the resistant pathogens that continue to be selected by current therapeutic regimens. This review provides a survey of known antimicrobial agents that were currently in clinical development in the fall of 2012 and spring of 2013. Data were collected from published literature primarily from 2010 to 2012, meeting abstracts (2011 to 2012), government websites, and company websites when appropriate. Compared to what was reported in previous surveys, a surprising number of new agents are currently in company pipelines, particularly in phase 3 clinical development. Familiar antibacterial classes of the quinolones, tetracyclines, oxazolidinones, glycopeptides, and cephalosporins are represented by entities with enhanced antimicrobial or pharmacological properties. More importantly, compounds of novel chemical structures targeting bacterial pathways not previously exploited are under development. Some of the most promising compounds include novel β-lactamase inhibitor combinations that target many multidrug-resistant Gram-negative bacteria, a critical medical need. Although new antimicrobial agents will continue to be needed to address increasing antibiotic resistance, there are novel agents in development to tackle at least some of the more worrisome pathogens in the current nosocomial setting.
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Affiliation(s)
| | - Karen Bush
- Indiana University, Bloomington, Indiana, USA
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37
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Hu J, Ma XX, Tian Y, Pang L, Cui LZ, Shang H. Reduced vancomycin susceptibility found in methicillin-resistant and methicillin-sensitive Staphylococcus aureus clinical isolates in Northeast China. PLoS One 2013; 8:e73300. [PMID: 24069184 PMCID: PMC3772004 DOI: 10.1371/journal.pone.0073300] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 07/18/2013] [Indexed: 11/18/2022] Open
Abstract
Background Strains of Staphylococcus aureus with an intermediate level of resistance to vancomycin (vancomycin-intermediate S. aureus, or VISA) or which contain subpopulations of mixed susceptibility (heterogeneous VISA, or hVISA) have been reported worldwide. However, the prevalence of VISA and hVISA infections in Northeast China is unknown. From 2007 through 2010, we surveyed the vancomycin susceptibility of methicillin-resistant and methicillin-sensitive S. aureus (MRSA and MSSA, respectively) clinical isolates in Northeast China. Methods S. aureus clinical isolates (369 MRSA and 388 MSSA) were screened for hVISA and VISA on brain heart infusion agar containing 3 μg/mL vancomycin, and their identity confirmed using a modified population analysis profile-area under the curve method and broth microdilution. All hVISA and VISA isolates were characterized genotypically and phenotypically. Results Ten percent and 0.5 percent of the isolates were hVISA and VISA, respectively. The proportion of hVISA among MSSA isolates for the entire study period was 4.1%, but increased significantly year-by-year, from 1.2% in 2007 to 7.2% in 2010. The predominant sources of hVISA and VISA isolates were sputum (56.3%), pus (18.8%), and blood (8.8%). Molecular typing of hVISA and VISA strains revealed that, taken together, 80% contained the accessory gene regulator (agr) group II, and of these, 85.7% of the MR-hVISA and MR-VISA strains were staphylococcal cassette chromosome mec (SCCmec) type II. The adherence ability of all hVISA and VISA strains was reduced compared with that of vancomycin-susceptible strains, shown by biofilm assay. Conclusions The percentage of hVISA strains was high and increased each year. The proportion of hVISA among MSSA specifically also increased significantly each year. In isolates collected from diverse infection sites, hVISA and VISA strains were found predominantly in sputum, pus, and blood, in descending order. Testing for vancomycin susceptibility should include both MRSA and MSSA isolates collected from different clinical sites.
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Affiliation(s)
- Jian Hu
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, People's Republic of China
- Department of Clinical Laboratory, Yixing Hospital of Traditional Chinese Medicine, Yixing, Jiangsu, People's Republic of China
| | - Xiao Xue Ma
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, People's Republic of China
| | - Yuan Tian
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, People's Republic of China
| | - Long Pang
- Department of Medical Microbiology and Parasitology, College of Basic Medical Sciences, China Medical University, Shenyang, People's Republic of China
| | - Long Zhu Cui
- Research Center for Anti-infectious Drugs, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Hong Shang
- Department of Clinical Laboratory, First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
- * E-mail:
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Clinical Outcomes in Patients with Heterogeneous Vancomycin-Intermediate Staphylococcus aureus Bloodstream Infection. Antimicrob Agents Chemother 2013; 57:4252-4259. [PMID: 23796929 DOI: 10.1128/aac.00380-13] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 06/14/2013] [Indexed: 01/30/2023] Open
Abstract
The prevalence of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) infections varies in the literature, a problem complicated by the lack of routine screening procedures; however, limited data suggest that hVISA has been associated with persistent bloodstream infections (BSI) and vancomycin failure, yet these studies have been confounded by design issues. We conducted this study to compare the characteristics of patients with BSI caused by hVISA with those with vancomycin-susceptible Staphylococcus aureus (VSSA) treated with vancomycin. This retrospective, multicenter matched (1:1) cohort study compared the clinical characteristics and outcomes of hVISA and VSSA. Patients with hVISA methicillin-resistant Staphylococcus aureus (MRSA) BSI from 2004 to 2012 were matched to VSSA-MRSA BSI patients. The primary outcome was failure of vancomycin treatment, defined as a composite of persistent bacteremia (≥7 days), persistent signs and symptoms, change of MRSA antibiotic, recurrent BSI, or MRSA-related mortality. We identified 122 matched cases. The overall vancomycin failure rate was 57% (82% hVISA versus 33% VSSA; P < 0.001). The individual components of failure in hVISA versus VSSA were persistent bacteremia, 59% versus 21% (P < 0.001); change in MRSA therapy, 54% versus 25% (P = 0.001); MRSA-related mortality, 21% versus 10% (P = 0.081); and recurrence of BSI, 26% versus 2% (P < 0.001). Using logistic regression analysis and adjusting for covariates, hVISA (adjusted odds ratio [aOR], 11.1; 95% confidence interval [CI], 4.3 to 28.7) and intensive care unit (ICU) admission (aOR, 4.5; 95% CI, 1.8 to 11.6) were still independently associated with vancomycin failure. Relative to VSSA BSI, patients with hVISA were more likely to experience failure of vancomycin treatment, including persistent bacteremia and recurrence. Our results indicate that hVISA was responsible for considerable morbidity.
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Moran GJ, Abrahamian FM, LoVecchio F, Talan DA. Acute Bacterial Skin Infections: Developments Since the 2005 Infectious Diseases Society of America (IDSA) Guidelines. J Emerg Med 2013; 44:e397-412. [DOI: 10.1016/j.jemermed.2012.11.050] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 11/02/2012] [Indexed: 01/22/2023]
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40
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The changing epidemiology of methicillin-resistant Staphylococcus aureus: 50 years of a superbug. Am J Infect Control 2013; 41:448-51. [PMID: 23219674 DOI: 10.1016/j.ajic.2012.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 06/27/2012] [Accepted: 06/27/2012] [Indexed: 11/20/2022]
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41
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Abstract
Multidrug-resistant organisms (MDROs) have emerged as important causes of healthcare-associated infections (HAIs), and these infections are associated with significant morbidity and mortality. Dialysis patients have been particularly affected by these pathogens, with colonization and infection rates often exceeding those seen in persons with other types of healthcare exposure. The infection control practices that are currently recommended for use in dialysis facilities and other healthcare settings have the potential to eliminate, or at least substantially reduce transmission of and infection with MDROs. Unfortunately, recent data suggest that these recommended practices are not consistently implemented. Additional efforts and research are needed to increase healthcare workers' awareness of and adherence to infection prevention measures, to develop new and more effective prevention strategies, and to determine cost-effective approaches to MDRO prevention to optimize the safety and quality of care provided to dialysis patients.
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Affiliation(s)
- David P Calfee
- Department of Medicine and Public Health, Weill Cornell Medical College, New York, NY, USA.
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42
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Garzoni C, Vergidis P. Methicillin-resistant, vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus infections in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:50-8. [PMID: 23464998 DOI: 10.1111/ajt.12098] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- C Garzoni
- Department of Internal Medicine and Infectious Diseases, Clinica Luganese, Lugano, Switzerland.
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Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, and other Gram-positives in healthcare. Curr Opin Infect Dis 2012; 25:385-94. [DOI: 10.1097/qco.0b013e3283553441] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Grayson ML, Charles PG, Howden BP. A Potential "Blind Spot" in Vancomycin Treatment Studies. Clin Infect Dis 2012; 55:165. [DOI: 10.1093/cid/cis333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Deresinski S. Methicillin-Resistant Staphylococcus aureus and Vancomycin: Minimum Inhibitory Concentration Matters. Clin Infect Dis 2012; 54:772-4. [DOI: 10.1093/cid/cir932] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Stan Deresinski
- Department of Medicine, Division of Infectious Disease and Geographic Medicine, Stanford University School of Medicine, California
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