Prevalence and clinical implications of Staphylococcus aureus with a vancomycin MIC of 4 microg/ml in Korea.
In addition to vancomycin-intermediate Staphylococcus aureus (VISA), S. aureus with a vancomycin MIC of 4 microg/ml has been reported to be the cause of therapeutic failure. This study was designed to determine the prevalence of methicillin-resistant S. aureus (MRSA) with a vancomycin MIC of 4 microg/ml and to clarify the clinical characteristics of infections caused by these isolates. During the 8-week period from April to May, 2001, 27 hospitals participated in a nationwide surveillance program for VISA and vancomycin-resistant S. aureus (VRSA) in Korea. After screening on brain-heart infusion agar containing 4 microg/ml of vancomycin as previously described, 100 isolates with confluent growth were tested. The medical records of the patients involved were reviewed. Even though VISA or VRSA was not detected among 3,756 MRSA isolates, 18 (0.5%) had a vancomycin MIC of 4 microg/ml. The infections in 12 of these patients, excluding 5 that were colonized, were 8 chronic osteomyelitis, 1 surgical site infection, 1 pneumonia, 1 intra-abdominal infection, and 1 catheter-related infection. Although 11 cases were exposed to glycopeptides for a long time (median 56 days), the site of infection became culture-negative in only 1 case. Two patients died of their S. aureus infections. MRSA with a vancomycin MIC of 4 microg/ml was rare. Chronic osteomyelitis was the most common type of infection, and prolonged exposure to glycopeptides was associated with reduced susceptibility to vancomycin.
Department of Microbiology, National Institute of Health, Seoul 122-701, Republic of Korea.
Hong Bin
HB
Kim
Yeong Seon
YS
Lee
Bong Su
BS
Kim
Jeong Ok
JO
Cha
Sung Uk
SU
Kwon
Hee Joo
HJ
Lee
Jin Tae
JT
Suh
Insoo
I
Rheem
Jeong Man
JM
Kim
Bo-Moon
BM
Shin
Mi-Na
MN
Kim
Kyungwon
K
Lee
Chang Seop
CS
Lee
Eui-Chong
EC
Kim
Myoung-Don
MD
Oh
Kang Won
KW
Choe
D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016521:Electrophoresis, Gel, Pulsed-Field; D006801:Humans; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics; D014640:Vancomycin / Q000494:pharmacology*; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents; D014640:Vancomycin