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ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 16-19

Clinical profile of patients with heteroresistant vancomycin- intermediate Staphylococcus aureus bacteraemia compared to those with methicillin-resistant Staphylococcus aureus bacteraemia at a level-1 trauma centre of India


1 Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
2 Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Dr. Purva Mathur
Room No. 211, Second Floor, Department of Laboratory Medicine, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpsic.jpsic_9_19

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Introduction: Staphylococcus aureus is the common cause of bacteraemia, skin/soft-tissue infections and pneumonia in both developed and developing countries, with many of them being caused by methicillin-resistant S. aureus (MRSA) strains. Vancomycin has been a reliable therapeutic option for MRSA infections. Vancomycin-resistant S. aureus and heterogeneous vancomycin-intermediate S. aureus (hVISA) strains have been reported to be associated with vancomycin treatment failure. The present study was performed to determine the percentage of infections due to hVISA and also to compare the clinical characteristics of patients with hVISA infections. Methods: The study was conducted at the department of microbiology of a 1600-bedded level 1 trauma centre of India. Vancomycin minimum inhibitory concentration (MIC) using Etest was performed for MRSA strains isolated from inpatients over 3 years, 2013 to 2015. Heteroresistance determination was done for strains with vancomycin MIC ≥1 μg/ml using Macro Etest method. Clinical data of all patients with MRSA and hVISA infection were compared. Results: A total of 837 S. aureus strains were collected. Of these, 371 (44.3%) were MRSA; 108 (12.9%) had vancomycin MIC ≥1 μg/ml and 32 (3.8%) strains had hVISA. Presence of hVISA infection was found to be significantly associated with the presence of prosthetic implants and surgical-site infections. These patients had prolonged duration of hospital stay and were also associated with vancomycin treatment failure. Discussion: Percentage of hVISA strains reported at our institution was 3.8%, which may be a reflection of community scenario. Mortality rate associated with hVISA bacteraemia was more than that observed with MRSA bacteraemia though not statistically significant. hVISA isolation was greater in high-bacterial–load infections such as blood and respiratory tract infections. Presence of high-bacterial-load MRSA infections for prolonged period despite adequate vancomycin treatment is an indirect clinical marker of hVISA infection.


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