title: Vancomycin MIC creep in MRSA isolates from 1997 to 2008 in a healthcare region in Hong Kong.
abstract: OBJECTIVE
  To assess whether vancomycin MIC creeps among blood methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered from 5 hospitals in Hong Kong from 1997 to 2008.
  
  
  METHODS
  Blood cultures MRSA isolates from 1997 to 1999 (period 1), 2004 (period 2) and 2006-2008 (period 3) were retrieved. Etest method was used to determine their vancomycin MIC. The genotypic features were determined by PCR and sequencing.
  
  
  RESULTS
  247 blood MRSA isolates were studied. The vancomycin MIC were 0.375, 0.5, 0.75 and 1 mg/L for 15 (6.1%), 68 (27.5%), 89 (36%) and 75 (30.4%) isolates, respectively. There was an increase in the percentage of isolates with an MIC=1mg/L from 10.4% (5/48) during period 1 to 21.6% (8/37) during period 2 and 38.3% (62/162) during period 3 (period 1 vs. period 3, P<0.001). Molecular typing showed that this was due to increased percentages of clonal cluster (CC) 8/SCCmec III/IIIA (agr group I), CC45/SCCmec IV/V (agr group IV) and other minor clones with elevated MIC over time.
  
  
  CONCLUSIONS
  This study found vancomycin MIC creep among blood MRSA isolates over time. As elevated MIC within the susceptible range may reduce vancomycin efficacy, clinical laboratories should adopt methods with the required precision to accurately determine MICs.
authors: Division of Infectious Diseases, Department of Microbiology and Centre of Infection, The University of Hong Kong, Queen Mary hospital, Pokfulam Road, Pokfulam, Hong Kong SAR, China. plho@hkucc.hku.hk
authors: Pak-Leung
authors: PL
authors: Ho
authors: Pui-Ying
authors: PY
authors: Lo
authors: Kin-Hung
authors: KH
authors: Chow
authors: Eric H Y
authors: EH
authors: Lau
authors: Eileen L
authors: EL
authors: Lai
authors: Vincent C C
authors: VC
authors: Cheng
authors: Richard Y
authors: RY
authors: Kao
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000382:microbiology*; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D006723:Hong Kong; D006761:Hospitals; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D013203:Staphylococcal Infections / Q000382:microbiology*; D014640:Vancomycin / Q000494:pharmacology*; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D014640:Vancomycin