title: A report on the first case of vancomycin-intermediate Staphylococcus aureus (VISA) in Hawai'i.
abstract: The state of Hawai'i has the highest prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection in the United States. Since vancomycin is the most frequently-prescribed antibiotic for healthcare-associated MRSA infection, there is concern for development of vancomycin resistance. We report on a 61 year-old woman with history of previous successful treatments of MRSA bacteremia with vancomycin. She was later hospitalized for catheter-related MRSA bacteremia that persisted despite vancomycin treatment. The vancomycin minimal inhibitory concentration (MIC) was initially 1-2 µg/ml, suggesting susceptibility, but changed to 4 µg/ml. At this level, the organism was classified as a vancomycin-intermediate Staphylococcus aureus (VISA). Therapy was changed from vancomycin to daptomycin, and the patient's blood cultures were sterilized. High suspicion of VISA should be raised in MRSA-infected patients who fail or have a history of vancomycin therapy so that additional susceptibility testing and appropriate antibiotic therapy can be promptly commenced to reduce the morbidity associated with VISA infection.
authors.affiliation: Department of Medicine, University of Hawai'i John A. Burns School of Medicine, Honolulu, USA. chsutti@hotmail.com
authors.forename: Suttirak
authors.initials: S
authors.lastname: Chaiwongkarjohn
authors.forename: Pornpoj
authors.initials: P
authors.lastname: Pramyothin
authors.forename: Nuntra
authors.initials: N
authors.lastname: Suwantarat
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bankowski
authors.forename: Terrie
authors.initials: T
authors.lastname: Koyamatsu
authors.forename: Steven E
authors.initials: SE
authors.lastname: Seifried
authors.forename: Erlaine F
authors.initials: EF
authors.lastname: Bello
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy*; D017576:Daptomycin / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects*; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use; D020713:Vancomycin Resistance / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D017576:Daptomycin