title: Prevalence and characteristics of heteroresistant vancomycin-intermediate Staphylococcus aureus bacteremia in a tertiary care center.
abstract: Infections with S. aureus with heterogeneous intermediate resistance to vancomycin (hVISA) are occurring more frequently. The detection of these infections, their prevalence, clinical characteristics, and significance are controversial. During 2003 and 2004, all blood culture isolates of methicillin-resistant Staphylococcus aureus (264 patients) at the Sheba Medical Center, Tel Hashomer, Israel, were assessed for hVISA by using the Etest macromethod. A total of 16 patients (6%) were positive for hVISA. Resistance to teicoplanin alone and to vancomycin alone using the Etest macromethod was found in 14 and 10 patients, respectively. Standard MICs to vancomycin were between 1 to 4 mg/ml. Most of these isolates (12 of 16 [75%]) would have been missed without specific testing. The median number of bacteremic days was 4. Seven patients had positive blood cultures for more than 5 days. Twelve patients died, and for eight of these the deaths were directly related to hVISA sepsis. We found that hVISA bacteremia was prevalent in our institution, and we suggest seeking hVISA in patients with persistent S. aureus bacteremia.
authors.affiliation: Infectious Disease Unit/Microbiology Laboratory, Tel Aviv University, Sheba Medical Center, Tel Hashomer 52621, Israel. maory@post.tau.ac.il
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Maor
authors.forename: Galia
authors.initials: G
authors.lastname: Rahav
authors.forename: Natasha
authors.initials: N
authors.lastname: Belausov
authors.forename: Debby
authors.initials: D
authors.lastname: Ben-David
authors.forename: Gill
authors.initials: G
authors.lastname: Smollan
authors.forename: Nathan
authors.initials: N
authors.lastname: Keller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000382:microbiology* / Q000401:mortality; D002675:Child, Preschool; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D015995:Prevalence; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects*; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents