title: Clinical features and treatment outcomes of vancomycin-intermediate Staphylococcus aureus (VISA) and heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) in a tertiary care institution in Singapore.
abstract: This retrospective case-control study was undertaken to review the clinical features associated with heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) and vancomycin-intermediate S. aureus (VISA) infections and the local impact they have on clinical outcome. Compared with vancomycin-susceptible S. aureus (n = 30), hVISA and VISA infections (n = 10) are found to be associated with a longer period of prior glycopeptide use (P = 0.01), bone/joint (P < 0.01) and prosthetic infections (P = 0.04), as well as treatment failure, as evidenced by longer bacteremic (P < 0.01) and culture positivity (P < 0.01) periods. This was observed to have resulted in longer hospital length of stay (P < 0.01) and total antibiotic therapy duration (P = 0.01). There was, however, no significant difference in the overall patient mortality or the hospitalization cost (P = 0.12) in both groups. Clinicians should be cognizant of the association between hVISA/VISA with high bacterial load deep-seated infections. We recommend targeted and even universal screening for hVISA/VISA in methicillin-resistant S. aureus (MRSA) infections.
authors.affiliation: Singapore General Hospital, Singapore, Singapore. fongraymond@hotmail.com
authors.forename: R K C
authors.initials: RK
authors.lastname: Fong
authors.forename: J
authors.initials: J
authors.lastname: Low
authors.forename: T H
authors.initials: TH
authors.lastname: Koh
authors.forename: A
authors.initials: A
authors.lastname: Kurup
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012846:Singapore; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology / Q000401:mortality; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D017211:Treatment Failure; D016896:Treatment Outcome; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents