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.
Kim
Hong Bin
HB
Department of Microbiology, National Institute of Health, Seoul 122-701, Republic of Korea.
Lee
Yeong Seon
YS
Kim
Bong Su
BS
Cha
Jeong Ok
JO
Kwon
Sung Uk
SU
Lee
Hee Joo
HJ
Suh
Jin Tae
JT
Rheem
Insoo
I
Kim
Jeong Man
JM
Shin
Bo-Moon
BM
Kim
Mi-Na
MN
Lee
Kyungwon
K
Lee
Chang Seop
CS
Kim
Eui-Chong
EC
Oh
Myoung-Don
MD
Choe
Kang Won
KW
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