title: Vancomycin intermediate-resistant Staphylococcus aureus (VISA) isolated from a patient who never received vancomycin treatment.
abstract: BACKGROUND
  With the abuse of antibiotics, the methicillin-resistant Staphylococcus aureus (MRSA) strain became prevalent. Furthermore, Staphylococcus aureus with a character of vancomycin intermediate-resistance (VISA) has been found globally since the first report in Japan. The main objectives of this study were to report a case of VISA isolated from a Chinese patient who had never undergone Vancomycin treatment, and to determine its molecular character.
  
  
  METHODS
  A total of 9 strains were recovered from a patient during the therapeutic process. Antimicrobial susceptibility testing was performed to determine their antibiotic susceptibility patterns. To detect the VISA strain's molecular epidemiological features, growth and morphological characters, we used multilocus sequence typing, autolysis assay and transmission electric microscope tests. Pulsed-field gel electrophoresis (PFGE) was performed to characterize the heterogeneities of all isolates.
  
  
  RESULTS
  One isolate was found to exhibit vancomycin intermediated-resistant with MIC of 8 μg/ml. It was ST239-T030-agr-1, had thickened cell wall, and displayed a slower growth rate and reduced susceptibility to Triton X-100-induced autolysis than other strains. All 9 strains exhibited the same PFGE pattern.
  
  
  CONCLUSIONS
  This is the first report of VISA found in central China from a patient who had never received vancomycin treatment.
authors.affiliation: Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Xuhui
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Department of Clinical Laboratory, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
authors.forename: Cailin
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Sui
authors.initials: S
authors.lastname: Gao
authors.affiliation: Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Yanfang
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Zhongju
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. Electronic address: tjszyong@163.com.
authors.forename: Ziyong
authors.initials: Z
authors.lastname: Sun
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002681:China; D016521:Electrophoresis, Gel, Pulsed-Field; D006801:Humans; D008297:Male; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents
keywords: Molecular typing; Staphylococcus; VISA; Vancomycin intermediated-resistant Staphylococcus aureus