1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Lopes SP, Jorge P, Sousa AM, Pereira MO. Discerning the role of polymicrobial biofilms in the ascent, prevalence, and extent of heteroresistance in clinical practice. Crit Rev Microbiol 2021; 47:162-191. [PMID: 33527850 DOI: 10.1080/1040841x.2020.1863329] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Antimicrobial therapy is facing a worrisome and underappreciated challenge, the phenomenon of heteroresistance (HR). HR has been gradually documented in clinically relevant pathogens (e.g. Pseudomonas aeruginosa, Staphylococcus aureus, Burkholderia spp., Acinetobacter baumannii, Klebsiella pneumoniae, Candida spp.) towards several drugs and is believed to complicate the clinical picture of chronic infections. This type of infections are typically mediated by polymicrobial biofilms, wherein microorganisms inherently display a wide range of physiological states, distinct metabolic pathways, diverging refractory levels of stress responses, and a complex network of chemical signals exchange. This review aims to provide an overview on the relevance, prevalence, and implications of HR in clinical settings. Firstly, related terminologies (e.g. resistance, tolerance, persistence), sometimes misunderstood and overlapped, were clarified. Factors generating misleading HR definitions were also uncovered. Secondly, the recent HR incidences reported in clinically relevant pathogens towards different antimicrobials were annotated. The potential mechanisms underlying such occurrences were further elucidated. Finally, the link between HR and biofilms was discussed. The focus was to recognize the presence of heterogeneous levels of resistance within most biofilms, as well as the relevance of polymicrobial biofilms in chronic infectious diseases and their role in resistance spreading. These topics were subject of a critical appraisal, gaining insights into the ascending clinical implications of HR in antimicrobial resistance spreading, which could ultimately help designing effective therapeutic options.
Collapse
Affiliation(s)
- Susana Patrícia Lopes
- CEB - Centre of Biological Engineering, LIBRO - Laboratory of Research in Biofilms Rosário Oliveira, University of Minho, Braga, Portugal
| | - Paula Jorge
- CEB - Centre of Biological Engineering, LIBRO - Laboratory of Research in Biofilms Rosário Oliveira, University of Minho, Braga, Portugal
| | - Ana Margarida Sousa
- CEB - Centre of Biological Engineering, LIBRO - Laboratory of Research in Biofilms Rosário Oliveira, University of Minho, Braga, Portugal
| | - Maria Olívia Pereira
- CEB - Centre of Biological Engineering, LIBRO - Laboratory of Research in Biofilms Rosário Oliveira, University of Minho, Braga, Portugal
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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: 130] [Impact Index Per Article: 32.5] [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.
Collapse
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.
| |
Collapse
|
5
|
Dalton BR, Dersch-Mills D, Langevin A, Sabuda D, Rennert-May E, Greiner T. Appropriateness of basing vancomycin dosing on area under the concentration-time curve. Am J Health Syst Pharm 2019; 76:1718-1721. [PMID: 31612932 DOI: 10.1093/ajhp/zxz184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Affiliation(s)
- Bruce R Dalton
- Department of Pharmacy Services Alberta Health Services, Calgary ZoneCalgary, Alberta, Canada
| | - Deonne Dersch-Mills
- Department of Pharmacy Services Alberta Health Services, Calgary ZoneCalgary, Alberta, Canada
| | - Ashten Langevin
- Department of Pharmacy Services Alberta Health Services, Calgary ZoneCalgary, Alberta, Canada
| | - Deana Sabuda
- Department of Pharmacy Services Alberta Health Services, Calgary ZoneCalgary, Alberta, Canada
| | - Elissa Rennert-May
- Departments of Medicine and Community Health SciencesCumming School of Medicine, University of Calgary Calgary, Alberta, Canada
| | - Thomas Greiner
- Department of Pathology and Laboratory MedicineUniversity of Calgary Calgary, Alberta, Canada
| |
Collapse
|
6
|
Vu DH, Nguyen DA, Delattre IK, Ho TT, Do HG, Pham HN, Dao XC, Tran NT, Nguyen GB, Van Bambeke F, Tulkens PM, Nguyen HA. Determination of optimal loading and maintenance doses for continuous infusion of vancomycin in critically ill patients: Population pharmacokinetic modelling and simulations for improved dosing schemes. Int J Antimicrob Agents 2019; 54:702-708. [PMID: 31600554 DOI: 10.1016/j.ijantimicag.2019.09.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Despite extensive clinical use, limited data are available on optimal loading and maintenance doses of vancomycin in critically ill patients. This study aimed to develop a rational approach for optimised dosage of vancomycin given in a continuous infusion in critically ill patients. METHODS Vancomycin pharmacokinetic (PK) data (total serum concentrations) were obtained from 55 intensive care unit (ICU) patients (Bach Mai Hospital, Hanoi, Vietnam) receiving a 20 mg/kg loading dose followed by continuous infusion stratified by creatinine clearance (CLCr). Population PK modelling and Monte Carlo simulations were performed using a nonlinear mixed-effects modelling (NONMEM) program for a target of 20-30 mg/L to optimise efficacy and minimise nephrotoxicity. RESULTS A two-compartment model with first-order elimination best fitted the PK data with central and peripheral volumes of distribution of 1.01 and 2.39 L/kg, respectively (allometric scaling to a 70 kg standard subject). The population total clearance of 3.63 L/h was only explained by renal function in the covariate and final model. The simulations showed that a 25-mg/kg loading dose infused over 90 minutes was optimal to reach the target range. The optimal maintenance dose for low renal function (CLCr < 45 mL/min) was 1000-1500 mg/day. For augmented renal clearance (CLCr > 130 mL/min) the dose should be up to 3500 mg/day or even 4500 mg/day to achieve adequate exposure. These simulated maintenance doses were larger than previously proposed for non-ICU patients. CONCLUSION Large loading and maintenance doses of vancomycin are generally needed in critically ill patients. Because of high interindividual variability in vancomycin PK, drug monitoring may still be necessary.
Collapse
Affiliation(s)
- Dinh H Vu
- National Drug Information and Adverse Drug Reaction Monitoring Center, Hanoi University of Pharmacy, Hanoi, Vietnam.
| | - Duy A Nguyen
- National Drug Information and Adverse Drug Reaction Monitoring Center, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Isabelle K Delattre
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Trong T Ho
- National Drug Information and Adverse Drug Reaction Monitoring Center, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Hong G Do
- Department of Pharmacy, Bach Mai Hospital, Hanoi, Vietnam
| | - Hong N Pham
- Department of Microbiology, Bạch Mai Hospital, Hanoi, Vietnam
| | - Xuan C Dao
- Intensive Care Unit, Bạch Mai Hospital, Hanoi, Vietnam
| | - Nhan T Tran
- Department of Pharmacy, Bach Mai Hospital, Hanoi, Vietnam
| | - Gia B Nguyen
- Intensive Care Unit, Bạch Mai Hospital, Hanoi, Vietnam
| | - Françoise Van Bambeke
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Hoang A Nguyen
- National Drug Information and Adverse Drug Reaction Monitoring Center, Hanoi University of Pharmacy, Hanoi, Vietnam
| |
Collapse
|
7
|
Wilcox M, Al-Obeid S, Gales A, Kozlov R, Martínez-Orozco JA, Rossi F, Sidorenko S, Blondeau J. Reporting elevated vancomycin minimum inhibitory concentration in methicillin-resistant Staphylococcus aureus: consensus by an International Working Group. Future Microbiol 2019; 14:345-352. [PMID: 30724113 PMCID: PMC6479275 DOI: 10.2217/fmb-2018-0346] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) remains an important cause of serious infection, for which vancomycin is often recommended as the first-choice antibiotic treatment. Appropriate vancomycin prescribing requires accurate measurement of minimum inhibitory concentrations (MICs) to avoid treatment failure, and yet determination can be challenging due to methodological difficulties associated with susceptibility testing. An International Working Group of infectious disease specialists and clinical/medical microbiologists reached a consensus that empirical MRSA infection therapies should be chosen regardless of the suspected origin of the infecting strain (e.g., community or hospital) due to the complex intermingling epidemiology of MRSA clones in these settings. Also, if an elevated vancomycin MIC in the susceptible range is obtained in routine testing, an alternative second method should be used for confirmation and to aid antibiotic therapy recommendations. There is no absolutely dependable method for the accurate determination of vancomycin MIC, but broth microdilution appears to be the most reliable.
Collapse
Affiliation(s)
- Mark Wilcox
- Leeds Teaching Hospitals NHS Trust & University of Leeds, Leeds, UK
| | - Suleiman Al-Obeid
- Microbiology Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ana Gales
- Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Roman Kozlov
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, Smolensk, Russia
| | - José A Martínez-Orozco
- Infectious Diseases & Clinical Microbiology Department, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Flavia Rossi
- Hospital das Clínicas da Faculdade de Medicina, Seção de Microbiologia, Divisão de Laboratório Central LIM03, Universidade de São Paulo, São Paulo, Brazil
| | - Sergey Sidorenko
- Department of Medical Microbiology & Molecular Epidemiology, Pediatric Research & Clinical Center for Infectious Diseases, Department of Medical Microbiology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
| | - Joseph Blondeau
- Department of Clinical Microbiology, Royal University Hospital, Saskatchewan, Canada
| |
Collapse
|