title: Worrisome trends in rising minimum inhibitory concentration values of antibiotics against methicillin resistant Staphylococcus aureus - Insights from a tertiary care center, South India.
abstract: BACKGROUND
  Appearance of isolated reports of resistance to anti-methicillin-resistant Staphylococcus aureus (MRSA) drugs is worrisome underscoring the need to continuously monitor the susceptibility of clinical MRSA isolates to these drugs. Hence, the present study is conducted to determine the susceptibility of MRSA isolates to various classes of anti-MRSA drugs such as vancomycin (glycopeptide), daptomycin (lipopeptide), tigecycline (glycylcycline), and linezolid (oxazolidinone) to determine the MIC50 and MIC90 values, and to observe MIC creep over a three year period, if any, with respect to these drugs.
  
  
  METHODS
  A total of 200 isolates of MRSA obtained from clinical specimens were included. MIC was determined by E-test for anti-MRSA antibiotics vancomycin, linezolid, daptomycin, and tigecycline. Non-parametric methods (Kruskal-Wallis and Chi-square test) were used to assess MIC trends over time. In addition, MIC50 and MIC90 values were also calculated.
  
  
  RESULTS
  No isolate was found resistant to vancomycin, daptomycin, or linezolid; five isolates were resistant to tigecycline. Seven VISA isolates were encountered with the MIC value for vancomycin of 4μg/mL. MIC values for vancomycin, tigecycline, linezolid showed a definite increase over a 3-year period which was statistically significant with p-values <0.0001, 0.0032, 0.0242, respectively. When the percentage of isolates with a median MIC value less than or equal to that of the index year was calculated, the change was most striking with vancomycin. The proportion of isolates with higher MIC values was greater in 2014 than 2012 and 2013.
  
  
  CONCLUSIONS
  MIC creep was notably observed with vancomycin, and to some extent with tigecycline and linezolid. Selection pressure may result in creeping MICs, which may herald the emergence of resistant organisms.
authors.affiliation: Department of Microbiology, JIPMER, Puducherry, India.
authors.forename: Nagasundaram
authors.initials: N
authors.lastname: Niveditha
authors.affiliation: Department of Microbiology, JIPMER, Puducherry, India. Electronic address: sujathasistla@gmail.com.
authors.forename: Sistla
authors.initials: S
authors.lastname: Sujatha
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D017576:Daptomycin / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D007194:India; D007928:Lethal Dose 50; D008712:Methicillin / Q000008:administration & dosage / Q000494:pharmacology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D008911:Minocycline / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology; D062606:Tertiary Care Centers; D000078304:Tigecycline; D014640:Vancomycin / Q000008:administration & dosage / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000078304:Tigecycline; D008911:Minocycline; D017576:Daptomycin; D008712:Methicillin
keywords: MIC creep; MRSA; VISA; Vancomycin