title: Heteroresistance to glycopeptides in Italian meticillin-resistant Staphylococcus aureus (MRSA) isolates.
abstract: The prevalence and molecular characterisation of heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) strains were determined in a large group of Italian strains isolated between 2005 and mid 2007. Amongst the 1284 strains isolated from documented infections in hospitalised patients (bloodstream infection, pneumonia, and skin and skin-structure infections), 139 S. aureus with vancomycin minimum inhibitory concentrations (MICs) between 1 mg/L and 2 mg/L were screened for the presence of hVISA using three different methods and were confirmed by population analysis profile (PAP). Thirty-six hVISA strains (25.9%) were detected. Amongst the three screening methods used, the macro Etest (MET) demonstrated 100% specificity and 75% sensitivity. hVISA strains were accessory gene regulator (agr) types I and II and belonged to the major nosocomial clones circulating in Italy (ST8, ST239, ST247 and ST228). All strains were susceptible to quinupristin/dalfopristin, linezolid, daptomycin, tigecycline and dalbavancin. In conclusion, we have demonstrated that hVISA isolates are common amongst MRSA isolates with MICs between 1 mg/L and 2 mg/L in Italy. MET, with its high sensitivity and specificity, should be used for early detection of hVISA, especially in patients with serious or prolonged infections sustained by MRSA. Finally, the most recent anti-Gram-positive drugs maintained their full spectrum of in vitro activity against these strains.
authors: Department of Microbiology, University of Catania (I), Catania, Italy.
authors: Floriana
authors: F
authors: Campanile
authors: Sonia
authors: S
authors: Borbone
authors: Marianna
authors: M
authors: Perez
authors: Dafne
authors: D
authors: Bongiorno
authors: Viviana
authors: V
authors: Cafiso
authors: Taschia
authors: T
authors: Bertuccio
authors: Simona
authors: S
authors: Purrello
authors: Daria
authors: D
authors: Nicolosi
authors: Cristina
authors: C
authors: Scuderi
authors: Stefania
authors: S
authors: Stefani
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D006801:Humans; D007558:Italy; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D011023:Pneumonia, Staphylococcal / Q000382:microbiology*; D013207:Staphylococcal Skin Infections / Q000382:microbiology*; D014640:Vancomycin / Q000494:pharmacology*; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin