Prevalence and Clinical Impact of Heterogeneous Vancomycin-Intermediate Staphylococcus aureus Isolated From Hospitalized Patients

• Published in: Annals of laboratory medicine Vol. 36; no. 3; pp. 235 - 243
• Main Authors: Koh, Young Rae, Kim, Kye Hyung, Chang, Chulhun L, Yi, Jongyoun
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society for Laboratory Medicine 01-05-2016; 대한진단검사의학회
• Subjects: Aged; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Bacteremia - drug therapy; Bacteremia - epidemiology; Bacteremia - microbiology; Drug Resistance, Bacterial - drug effects; Female; Hospital Mortality; Hospitalization; Humans; Male; Methicillin-Resistant Staphylococcus aureus - drug effects; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Microbial Sensitivity Tests; Middle Aged; Original; Phenotype; Pneumonia - drug therapy; Pneumonia - epidemiology; Pneumonia - microbiology; Prevalence; Republic of Korea - epidemiology; Staphylococcus aureus - drug effects; Staphylococcus aureus - isolation & purification; Teicoplanin - pharmacology; Vancomycin - pharmacology; Vancomycin - therapeutic use; 병리학; Glycopeptide resistance detection E test; Heterogeneous vancomycin-intermediate Staphylococcus aureus; S. aureus bacteremia; Macromethod E test; S. aureus pneumonia
• ISSN: 2234-3806; 2234-3814
• DOI: 10.3343/alm.2016.36.3.235

We estimated the prevalence and clinical impact of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA). The concordance between macromethod and glycopeptide resistance detection (GRD) E tests was determined. In addition, predictors of clinical outcomes in hospitalized patients with S. aureus bacteremia (SAB) or pneumonia (SAP) were evaluated.
We obtained 229 consecutive S. aureus isolates from all hospitalized patients at two university hospitals located in Busan and Yangsan, Korea. Standard, macromethod, and GRD E tests were performed. Additionally, we reviewed the medical records of all patients. Among the 229 patients, predictors of clinical outcomes were analyzed for 107 patients with SAB and 39 with SAP.
Among the 229 isolates, 34.5% of S. aureus isolates and 50.7% of methicillin-resistant S. aureus isolates exhibited the hVISA phenotype based on the macromethod E test. hVISA was nearly associated with treatment failure in patients with SAB (P=0.054) and was significantly associated with treatment failure in patients with SAP (P=0.014). However, hVISA was not associated with 30-day mortality in patients with SAB or SAP. The concordance between the macromethod and GRD E tests was 84.2%.
hVISA is quite common in the southeastern part of Korea. hVISA is associated with treatment failure in patients with SAP.