Vancomycin-resistant Staphylococcus aureus in the United States, 2002-2006.
BACKGROUND
This report compares the clinical characteristics, epidemiologic investigations, infection-control evaluations, and microbiologic findings of all 7 of the cases of vancomycin-resistant Staphylococcus aureus (VRSA) infection in the United States during the period 2002-2006.


METHODS
Epidemiologic, clinical, and infection-control information was collected. VRSA isolates underwent confirmatory identification, antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and typing of the resistance genes. To assess VRSA transmission, case patients and their contacts were screened for VRSA carriage.


RESULTS
Seven cases were identified from 2002 through 2006; 5 were reported from Michigan, 1 was reported from Pennsylvania, and 1 was reported from New York. All VRSA isolates were vanA positive and had a median vancomycin minimum inhibitory concentration of 512 microg/mL. All case patients had a history of prior methicillin-resistant S. aureus and enterococcal infection or colonization; all had several underlying conditions, including chronic skin ulcers; and most had received vancomycin therapy prior to their VRSA infection. Person-to-person transmission of VRSA was not identified beyond any of the case patients. Infection-control precautions were evaluated and were consistent with established guidelines.


CONCLUSIONS
Seven patients with vanA-positive VRSA have been identified in the United States. Prompt detection by microbiology laboratories and adherence to recommended infection control measures for multidrug-resistant organisms appear to have prevented transmission to other patients.
Sievert
Dawn M
DM
Michigan Department of Community Health, Lansing, USA. DSievert@cdc.gov
Rudrik
James T
JT
Patel
Jean B
JB
McDonald
L Clifford
LC
Wilkins
Melinda J
MJ
Hageman
Jeffrey C
JC
D000328:Adult; D000368:Aged; D001426:Bacterial Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques; D019729:Carbon-Oxygen Ligases / Q000235:genetics; D002353:Carrier State / Q000382:microbiology; D004269:DNA, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D005192:Family Health; D005260:Female; D005838:Genotype; D019983:Guideline Adherence; D006801:Humans; D017053:Infection Control; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology* / Q000635:transmission; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D014481:United States / Q000453:epidemiology; D020713:Vancomycin Resistance / Q000235:genetics*
D001426:Bacterial Proteins; D004269:DNA, Bacterial; C071437:VanA ligase, Bacteria; D019729:Carbon-Oxygen Ligases