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Category: Volume 06 Issue 08 August 2018
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Title: Detection of Vancomycin susceptibility including h-VISA among Methicillin resistant Staphylococcus aureus and Staphylococcus species isolated from orthopaedic device associated infections in a tertiary care hospital

Authors: Dr Sujatha.K, Dr Madhumathy.A

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i8.26

Abstract

Globally, Staphylococcus aureus is the major causative organism for medical device associated infections. Of this, the proportion of Methicillin resistant Staphylococcus aureus (MRSA) has worldwide for the last two decades. Treatment of choice for MRSA is vancomycin, however, resistance to vancomycin by Staphylococcus species is being encountered from the midst of 1990’s. This study was conducted on 90 Pus samples from the wound of the infected orthopaedic implant, out of that, 75 isolates are pathogens and among that, 59 isolates are identified as Staphylococcus species, of which 31 isolates are Staphylococcus aureus and 28 isolates are Staphylococcus epidermidis. Among 31 Staphylococcus aureus, 19 are MSSA and 12 are MRSA, similarly in 28 Staphylococcus epidermidis 16 are MSSE and 12 are MRSE. Totally 24 isolates were Methicillin resistant Staphylococcus species, of which 14 isolates are showing multidrug resistance. Therefore, these 14 isolates (11 isolates of MRSA and 3 isolates of MRSE) are subjected to vancomycin MIC by using Agar dilution (0.5 & 2 McFarland standards) and Micro-broth dilution (0.5 McFarland standards) methods. Out of 14 tested, only 5 isolates are detected as VISA, and are screened for hVISA also, by using GRD E-test and no hVISA /hGISA are found. Hence, from the 14 isolates, 6 are VSSA, 5 are VISA and 3 are VSSE.

Keywords: MSSA-Methicillin sensitive Staphylococcus aureus, MRSA- Methicillin resistant Staphylococcus aureus, MSSE- Methicillin sensitive Staphylococcus epidermidis, MRSE- Methicillin resistant Staphylococcus epidermidis, VSSA-Vancomycin susceptible Staphylococcus aureus, VISA- Vancomycin intermediate Staphylococcus aureus, hVISA- Heteroresistant Vancomycin intermediate Staphylococcus aureus, VRSA- Vancomycin resistant Staphylococcus aureus, GRD E-Test-Glycopeptide resistant detection Epsilometer Test, CLSI-Clinical and Laboratory standards  Institute, MIC-Minimum inhibitory concentration.

References

  1. Auttawit Sirichoat1;Sujintana Wongthong 1; Ratdawan Kanyota 1 ; Ratree Tavichakorntrakool2 ; Aroonwadee Chanawong 2 ; Jariya Umka Welbat 3 ; and Aroonlug Lulitanond 2, * Article Type: Research Article;  Received: Dec 13, 2014; Revised: Oct 5, 2015;  Accepted: Oct 16, 2015; epub: Jan 2, 2016; collection: Jan 2016Phenotypic Characteristics of Vancomycin-Non-Susceptible Staphylococcus aureus
  2. Biedenbach DJ, Bell JM, Sader HS, Fritsche TR, Jones RN, Turnidge JD. Antimicrobial susceptibility of gram-positive bacterial isolates from the Asia-Pacific region and an in vitro evaluation of the bactericidal activity of daptomycin, vancomycin, and teicoplanin.
  3. Benjamin P. Howden,1,2,3,4,*John K. Davies,3 Paul D. R. Johnson,1,3,4 Timothy P. Stinear,3,4,* and  Lindsay Grayson1,5,6 Reduced Vancomycin Susceptibility in Staphylococcus aureus, Including Vancomycin-Intermediate and Heteroge-neous Vancomycin-Intermediate Strains: Resistance Mechanisms, Laboratory Detection, and Clinical Implications
  4. Clinical and Laboratory Standards Institute CLSI; 2016. Performance Standards   for Antimicrobial Susceptibility Testing. CLSI approved standard -CLSI _M100S guidelines page no: 77.
  5. Clinical and Laboratory Standards Institute CLSI; 2016. Performance  Standards   for Antimicrobial Susceptibility Testing. CLSI approved standard -CLSI _M100S guidelines page no: 78.
  6. Clinical and Laboratory Standards Institute. CLSI; 2016. Performance Standards for Antimicrobial Susceptibility Testing. CLSI approved standard -CLSI  guidelines page no:202 &204.
  7. N. Chaudhari, Surg Cdr,a,∗K. Tandel, Maj,b N. Grover, Col,c S. Sen, Col,d P. Bhatt, Maj,e A.K. Sahni, Brig,f and A.K. Praharaj, Surg Cmde (Retd)Heterogeneous vancomycin-intermediate among methicillin resistant Staphylococcus aureus
  8. Chaohui Lu,1Yinjuan Guo,2 Shanshan Wang,2 Zhengzheng Wang,2 Lan Chen,2  Jinnan Lv,2 Xiuqin Qi,2 Zengqiang Chen,2  Lizhong Han,3 Xueqing Zhang,2  Liangxing Wang,4,* and Fangyou Yu2, Decreased Vancomycin MICs among Methicillin-Resistant Staphylococcus aureus Clinical Isolates at a Chinese Tertiary Hospital over a 12-year Period* Published online 2016 Oct 27. 
  9. Dhaifallah .A.Alenizi -Prevalence ofStaphylococcus aureus and antibiotic resistance in children with atopic dermatitis in Arar, Saudi Arabia
  10. Holmes RL, Jorgensen JH. Inhibitory activities of 11 antimicrobial agents and bactericidal activities of vancomycin and daptomycin against invasive methicillin-resistant Staphylococcus aureus isolates obtained from 1999 through 2006.
  11. Harigaya Y, Ngo D, Lesse AJ, Huang V, Tsuji BT. Characterization of heterogeneous vancomycin-intermediate resistance, MIC and accessory gene regulator (agr) dysfunction among clinical bloodstream isolates of staphyloccocus aureus. BMC Infect Dis. 2011;11:287.
  12. Hu J, Ma XX, Tian Y, Pang L, Cui LZ, Shang H. Reduced vancomycin susceptibility found in methicillin-resistant and methicillin-sensitive Staphylococcus aureus clinical isolates in Northeast China.PLoS One. 2013;8(9):eee73300
  13. Howden B.P. Danes.J.K et al –Reduced Vancomycin susceptibility in staphylococcus aureus including VISA & hVISA resistance mechanism,lab diagnosis and clinical implications.
  14. Horne, Howden et al-A prospective comparison of the cinical impact of hVISA and Vancomycin susceptible MRSA.
  15. Howden BP,Peleg AY, Stinear TP.-The evolution of vancomycin intermediate Staphylococcus aureus (VISA) and heterogenous-VISA.
  16. Iyer R.N., Hittinahalli V. Modified PAP method to detect heteroresistance to vancomycin among methicillin resistant Staphylococcus aureus isolates at a tertiary care hospital. Indian J Med Microbiol.2008;26:176–179. 
  17. Jasmine Chong,1Chelsea Caya,1 Simon Lévesque,2 and Caroline Quach1,3,* Heteroresistant Vancomycin Intermediate Coagulase Negative Staphylococcus in the NICU: A Systematic Review Published online 2016 Oct 7. 
  18. Jones RN. Key considerations in the treatment of complicated staphylococcal infections. Clin Microbiol Infect. 2008; 14 Suppl 2: 3–9.
  19. Leonard, S. N., K. L. Rossi, K. L. Newton, and M. J. Rybak. Evaluation of the E-test GRD for the detection of  Staphylococcus aureus with reduced susceptibility to glycopeptides. J. Antimicrob. Chemother. 63:489-492. 
  20. Mandell Douglas and Bennetts’s –Principles and Practice of Infectious diseases-8th Edition(pg.no-377-400)
  21. May J, Shannon K, King A, French G. Glycopeptide tolerance in Staphylococcus aureus. J Antimicrobi Chemother. 1998; 42: 189–197.
  22. Musta A.C., Riedere K., Shemes S. Vancomycin MIC plus heteroresistance and outcome of methicillin –resistant Staphylococcus aureus bacteremia: trends over 11 years. J Clin Microbiol. 2009;47:1640–1644.
  23. Mackie and McCartney-Practical medical Microbiology -14 th edition Page.no: 851.
  24. Park KH1, Kim ES, Kim HS, Park SJ, Bang KM, Park HJ, Park SY, Moon SM, Chong YP, Kim SH, Lee SO, Choi SH, Jeong JY, Kim MN, Woo JH, Kim YS.Comparison of the clinical features, bacterial genotypes and outcomes of patients with bacteraemia due to heteroresistant vancomycin-intermediate Staphylococcus aureus and vancomycin-susceptible S.aureus.
  25. Rose WE, Fallon M, Moran JJM, Vanderloo JP. Vancomycin tolerance in methicillin-resistant Staphylococcus aureus: influence of vancomycin, daptomycin, and telavancin on differential resistance gene expression. Antimicrob Agents Chemother. 2012; 56: 4422–4427. doi: 10.1128/AAC.00676-12.
  26. Sader HS, Jones RN, Rossi KL, Rybak MJ. Occurrence of vancomycin-tolerant and heterogeneous vancomycin-intermediate strains (hVISA) among  Staphylococcus aureus causing bloodstream infections in nine USA hospitals. J Antimicrob Chemother. 2009; 64: 1024–1028. doi: 10.1093/jac/dkp319.
  27. Tebelay Dilnessa 1and Adane Bitew-Prevalence and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus isolated from clinical samples at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
  28. Vicenta Cázares-Domínguez,Ariadnna Cruz-Córdova,Sara A. Ochoa,Gerardo Escalona,José Arellano-Galindo,Alejandra Rodríguez-Leviz,Rigoberto Hernández-Castro,Edgar O. López-Villegas,Juan Xicohtencatl-Cortes Vancomycin Tolerant, Methicillin-Resistant Staphylococcus aureus Reveals the Effects of Vancomycin on Cell Wall Thickening
  29. van Hal SJ, Lodise TP, Paterson DL. The clinical significance of vancomycin minimum inhibitory concentration in Staphylococcus aureus infections: a systematic review and meta-analysis. Clin Infect Dis.2012;54(6):755–71. doi: 10.1093/cid/cir935. 
  30. Wootton M., Hillman H.R., Walse T.R. A modified population analysis profile (PAP) method to detect hetero-resistance to vancomycin in Staphylococcus aureusin a UK hospital. J Antimicrob Chemother 2001;47:399–403.
  31. Yusof, A., A. Engelhardt, A. Karlsson, L. Bylund, P. Vidh, K. Mills, M. Wootton, and T. R. Walsh. Evaluation of a new Etest vancomycin-teicoplanin strip for detection of glycopeptide-intermediate Staphylococcus aureus (GISA), in particular, heterogeneous GISA. J. Clin. Microbiol. 46:3042-3047. 
  32. Yamuna Devi Bakthavatchalam,aBalaji Veeraraghavan, a John Victor Peter,b  Janakiraman Rajinikanth,c Francis Yesurajan Inbanathan,a Naveen Kumar Devanga Ragupathi,a and Suresh Kumar Rajamani Sekaral Novel Observations in 11 Heteroresistant Vancomycin-Intermediate Methicillin-Resistant Staphylococcus aureus Strains from South India Published online 2016 Dec 22.  doi:  1128/genomeA.01425-16
  33. Yuki Katayama, aMiwa Sekine,a Tomomi Hishinuma,a Yoshifumi Aiba,b and Keiichi HiramatsubComplete Reconstitution of the Vancomycin-Intermediate Staphylococcus aureus Phenotype of Strain Mu50 in Vancomycin-Susceptible  aureus Published online 2016 May 23.
  34. Zohreh Aminzadeh,1,2 Davood Yadegarynia,1 Alireza Fatemi,1,* Elham Tahmasebian Dehkordi,1 and Saeed Azad Armaki Vancomycin Minimum Inhibitory Concentration for Methicillin-Resistant Staphylococcus aureus Infections; Is There Difference in Mortality Between Patients? Published online 2014 Oct 1.  doi:  10.5812/jjm.12831.

Corresponding Author

Dr Sujatha.K

Stanley Medical College