Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-12-01T00:23:57.027Z Has data issue: false hasContentIssue false
  • English
  • Français

Isolation in Brazil of Nosocomial Staphylococcus aureus With Reduced Susceptibility to Vancomycin

Published online by Cambridge University Press:  02 January 2015

Geraldo A. Oliveira ,
Adriana M. Dell'Aquila ,
Rita L. Masiero ,
Carlos E. Levy ,
Marcia S. Gomes ,
Longzhu Cui ,
Keiichi Hiramatsu  and
Elsa M. Mamizuka
Geraldo A. Oliveira*
Affiliation:
Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
Adriana M. Dell'Aquila
Affiliation:
General Public Hospital, São Paulo, Brazil
Rita L. Masiero
Affiliation:
General Public Hospital, São Paulo, Brazil
Carlos E. Levy
Affiliation:
Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
Marcia S. Gomes
Affiliation:
General Public Hospital, São Paulo, Brazil
Longzhu Cui
Affiliation:
Department of Bacteriology, Juntendo University, Tokyo, Japan
Keiichi Hiramatsu
Affiliation:
Department of Bacteriology, Juntendo University, Tokyo, Japan
Elsa M. Mamizuka
Affiliation:
Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
*
Av Prof Lineu Prestes, 580, Cidade Universitaria, São Paulo, Brazil, CEP: 05508-900
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate the possible presence of vancomycin-resistant Staphylococcus aureus (VRSA) in a Brazilian hospital.

Design:

Epidemiological and laboratory investigation of nosocomial VRSA

Methods:

140 methicillin-resistant S aureus strains isolated between November 1998 and October 1999 were screened for susceptibility to vancomycin. The screening was carried out by using brain-heart infusion agar (BHIA) supplemented with 4, 6, and 8 μg/mL of vancomycin. The minimum inhibitory concentration (MIC) determination was carried out as standardized by the National Committee for Clinical Laboratory Standards using the broth macrodilution, agar-plate dilution, and E-test methods.

Patients:

Hospitalized patients exposed to vancomycin.

Results:

5 of the 140 isolates had a vancomycin MIC of 8 μg/mL by broth macrodilution, agar plate dilution, and E-test methods. Four VRSA strains were isolated from patients in a burn unit who had been treated with vancomycin for more than 30 days, and one from an orthopedic unit patient who had received vancomycin treatment for 7 days. Pulsed-field gel electrophoresis characterized four of the VRSA strains as belonging to the Brazilian endemic clone. All five strains were negative for vanA, vanB, and vanC genes by polymerase chain reaction. Transmission electron microscopy of the five strains revealed significantly thickened cell walls. One patient died due to infection caused by the VRSA strain.

Conclusions:

This is the first report of isolation of VRSA in Brazil and the first report of isolation of multiple VRSA strains from one facility over a relatively short period of time. This alerts us to the possibility that VRSA may be capable of nosocomial transfer if adequate hospital infection control measures are not taken.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 7 , July 2001 , pp. 443 - 448
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hiramatsu, K. Vancomycin resistance in staphylococci. Drug Resistance Updates 1998;1:135–150.Google Scholar
2.Smith, TL, Pearson, ML, Wilcox, KR, Cruz, C, Lancaster, MV, Robinson-Dunn, B, et al.Emergence of vancomycin resistance in Staphylococcus aureus. N Engl J Med 1999;340:493–501.CrossRefGoogle ScholarPubMed
3.Hiramatsu, K, Hanaki, H, Ino, T, Yabuta, K, Oguri, T, Tenover, FC. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother 1997;40:135–136.Google Scholar
4.Hiramatsu, K, Aritaka, N, Hanaki, H, Kawasaki, S, Hosoda, Y, Hori, S, et al.Dissemination in Japanese hospitals of strains of Staphylococcus aureus heterogeneously resistant to vancomycin. Lancet 1997;350:670–1673.Google Scholar
5.Ploy, MC, Grelaud, C, Martin, C, Lumley, L, Denis, F. First clinical isolate of vancomycin-intermediate Staphylococcus aureus in a French hospital. Lancet 1998;351:1212.Google Scholar
6.Tenover, FC, Lancaster, MY, Hill, BC, Steward, CD, Stocker, AS, Hancock, GA, et al.Characterization of staphylococci with reduced susceptibilities to vancomycin and other glycopeptides. J Clin Microbiol 1998;36:1020–1027.CrossRefGoogle ScholarPubMed
7.Rotum, SS, McMath, V, Schoonmaker, DJ, Maupin, PS, Tenover, FC, Hill, BC, et al.Staphylococcus aureus with reduced susceptibility to vancomycin isolated from a patient with fatal bacteremia. Emerg Infect Dis 1999;5:147–149.Google Scholar
8.Sieradzki, K, Roberts, RB, Haber, SW, Tomasz, A. The development of vancomycin resistance in a patient with methicillin-resistant Staphylococcus aureus infection. N Engl J Med 1999;340:517–523.Google Scholar
9.Ferraz, V, Duse, AG, Kassel, M, Black, AD, Ito, T, Hiramatsu, K. Vancomycin-resistant Staphylococcus aureus occurs in South Africa. S Afr Met J 2000;90:1113.Google Scholar
10.Kim, MN, Pai, CH, Woo, JH, Ryu, JS, Hiramatsu, K. Vancomycin-intermediate Staphylococcus aureus in Korea. J Clin Microbiol 2000;38:3879–3881.Google Scholar
11.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. Approved Standard M2-A6. 6th ed. NCCLS; Villanova, PA; 1997.Google Scholar
12.Cui, L, Murakami, H, Kuwahara-Arai, K, Hanaki, H, Hiramatsu, K. Contribution of a thickened cell wall and its glutamine nonamidated component to the vancomycin resistance expressed by Staphylococcus aureus Mu50. Antimicrob Agents Chemother 2000;44:2276–2285.Google Scholar
13.British Society for Antimicrobial Chemotherapy. A Guide to Sensitivity Testing. Report of the Working Party on Antibiotic Sensitivity Testing of the British Society for Antimicrobial Chemotherapy. London, UK; Academic Press; 1991.Google Scholar
14.Clark, NC, Cooksey, RC, Hill, BC, Swenson, JM, Tenover, FC. Characterization of glycopeptide-resistant enterococci from U.S. hospitals. Antimicrobial Agents Chemother 1993;37:2311–2317.Google Scholar
15.Satake, S, Clark, N, Kmland, D, Nolte, FS, Tenover, FC. Detection of vancomycin-resistant enterococci in fecal samples by PCR. J Clin Microbiol 1997;35:2325–2330.Google Scholar
16.Goering, RV. Molecular epidemiology of nosocomial infection: analysis of chromosomal restriction fragment patterns by pulsed-field gel electrophoresis. Infect Control Hosp Epidemiol 1993;14:595–600.Google Scholar
17.Tenover, FC, Arbeit, RD, Goering, RV, Mickelsen, PA, Murray, BE, Persing, DH, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
18.Hanaki, H, Kuwahara-Arai, K, Boyle-Vavra, S, Daum, RS, Labischinski, H, Hiramatsu, K. Activated cell-wall synthesis is associated with vancomycin resistance in methicillin-resistant Staphylococcus aureus clinical strains Mu3 and Mu50. J Antimicrob Chemother 1998;42:199–209.Google Scholar
19.Teixeira, LA, Resende, CA, Ormonde, LR, Rosenbaum, R, Figueiredo, AMS, de Lencastre, H, et al.Geographic spread of epidemic multire-sistant Staphylococcus aureus clone in Brazil. J Clin Microbiol 1995;33:2400–2404.CrossRefGoogle Scholar
20.Sader, HS, Pignatari, AC, Hollis, RJ, Jones, RN. Evaluation of interhospital spread of methicillin-resistant Staphylococcus aureus in Sao Paulo, Brazil, using pulsed-field gel electrophoresis of chromosomal DNA. Infect Control Hosp Epidemiol 1994;15:320–323.CrossRefGoogle Scholar
21.Tenover, FC. Implications of vancomycin-resistant Staphylococcus aureus. J Hosp Infect 1999;43(suppl):S3–S7.CrossRefGoogle ScholarPubMed
22.Centers for Disease Control and Prevention. Interim guidelines for prevention and control of staphylococcal infection associated with reduced susceptibility to vancomycin. MMWR 1997;46:626–628, 635.Google Scholar
23.Rice, TL. Simplified dosing and monitoring of vancomycin for the burn care clinician. Burns 1992;5:355–361.CrossRefGoogle Scholar
24.Mayhall, CG. Nosocomial burn wound infections. In: Mayhall, CG. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Wilkins; 1996:225–236.Google Scholar
25.Aeschlimann, JR, Hershberger, E, Rybak, M. Analysis of vancomycin populations susceptibility profiles, killing activity, and postantibiotic effect against vancomycin-intermediate Staphylococcus aureus. Antimicrob Agents Chemother, 1999;43:1914–1918.Google Scholar
26.Boyle-Vavra, S, Berke, SK, Lee, JC, Daum, RS. Reversion of the glycopeptide resistance phenotype in Staphylococcus aureus clinical isolates. Antimicrob Agents Chemother 2000;44:272–277.Google Scholar
27.Pfeltz, RF, Singh, VK, Schmidt, JL, Batten, MA, Baranyk, CS, Nadakavukaren, MJ, et al.Characterization of passage-selected vancomycin-resistant Staphylococcus aureus strains of diverse parental backgrounds. Antimicrob Agents Chemother 2000;44:294–303.Google Scholar
28.Howe, RA, Wootton, M, Walsh, TC, Bennett, PM, McGowan, AP. Expression and detection of hetero-vancomycin resistance in Staphylococcus aureus. J Antimicrob Chemother 1999;44:675–678.Google Scholar
29.Hiramatsu, K. The emergence of Staphylococcus aureus with reduced susceptibility to vancomycin in Japan. Am J Med 1998;104(suppl 5A):7S–10S.CrossRefGoogle ScholarPubMed
30.Prieto, J, Aguilar, L, Giménez, MJ, Toro, D, Gómez-Lus, ML, Dal-Ré, R, et al.In vitro activities of co-amoxiclav at concentrations achieved in human serum against the resistant subpopulation of heteroresistant Staphylococcus aureus: a controlled study with vancomycin. Antimicrob Agents Chemother 1998;42:1574–1577.Google Scholar
31.Climo, MW, Patron, RL, Archer, GL. Combinations of vancomycin and β-lactams are synergistic against staphylococci with reduced susceptibilities to vancomycin. Antimicrob Agents Chemother 1999;43:1747–1753.Google Scholar
32.Pannuti, CS, Grinbaum, RS. An overview of nosocomial infection control in Brazil. Infect Control Hosp Epidemiol 1995;16:170–174.Google Scholar
33.Oliveira, GA, Levy, CE, Mamizuka, EM. Staphylococcus aureus with intermediate resistance to vancomycin: mechanisms of resistance, laboratory detection and perspectives of appearance in Brazil. J Bras Pat 2000;36:96–102.Google Scholar
34.Hubert, SK, Mohammed, JM, Fridkin, SK, Gaynes, RP, McGowan, JE, Tenover, FC. Glycopeptide-intermediate Staphylococcus aureus: evaluation of a novel screening method and results of a survey of selected U.S. hospitals. J Clin Microbiol 1999;37:3590–3593.Google Scholar