Low Colonization Prevalence of Staphylococcus aureus with Reduced Vancomycin Susceptibility among Patients Undergoing Hemodialysis in the San Francisco Bay Area
| Autor: | Henry F. Chambers, Catherine Liu, Julie Louise Gerberding, José M. Eguía, Joan T. Pont, Matthew R. Moore, Elizabeth M. Wrone |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Microbiology (medical) Staphylococcus aureus medicine.medical_specialty Meticillin Micrococcaceae medicine.drug_class medicine.medical_treatment Antibiotics Nose medicine.disease_cause Microbiology Cohort Studies Renal Dialysis Risk Factors Vancomycin Internal medicine Drug Resistance Bacterial Prevalence Humans Medicine Prospective Studies Aged Antibacterial agent Aged 80 and over biology business.industry Middle Aged Staphylococcal Infections biology.organism_classification Infectious Diseases Carriage Carrier State Female San Francisco Hemodialysis business medicine.drug |
| Zdroj: | Clinical Infectious Diseases. 40:1617-1624 |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1086/429906 |
| Popis: | BACKGROUND Staphylococcus aureus exhibits varying degrees of reduced vancomycin susceptibility, and strains with intermediate levels of resistance are thought to emerge by antibiotic selection of subpopulations in heterogeneously resistant precursor strains exposed to this antibiotic. We sought to determine the prevalence of and risk factors for carriage of potential heterogeneous vancomycin-intermediate S. aureus (hVISA). METHODS We prospectively observed a cohort of 211 patients undergoing hemodialysis and performed quarterly surveillance cultures for up to 2 years. We screened for reduced vancomycin susceptibility using brain-heart infusion agar with 4 microg/mL vancomycin. RESULTS We identified 10 colonizing potential hVISA isolates recovered from 7 patients among both methicillin-susceptible and methicillin-resistant S. aureus strains. No confirmed hVISA isolates were identified; we can be 95% certain that the prevalence of confirmed hVISA carriage does not exceed 1.4%. When compared with noncolonized hemodialysis patients, neither vancomycin exposure, duration of hospitalization, nor any baseline clinical or demographic factor was found to predict colonization with potential hVISA on univariate analyses; increased number of months receiving hemodialysis was associated with potential hVISA colonization on multivariate analysis. CONCLUSIONS Despite numerous published reports of S. aureus with reduced vancomycin susceptibility, carriage of these isolates remains a rare phenomenon. Given the unclear clinical significance of potential hVISA, it is not clear whether clinical laboratories should identify such strains, or how they should do so. |
| Databáze: | OpenAIRE |
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