Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug;150(2):194-198.
doi: 10.4103/ijmr.IJMR_1976_17.

Detection of heterogeneous vancomycin-intermediate Staphylococcus aureus: A preliminary report from south India

Rajesh Amberpet  1 , Sujatha Sistla  1 , Madhan Sugumar  1 , Niveditha Nagasundaram  1 , Meerabai Manoharan  1 , Subhash Chandra Parija  1
Affiliations

Detection of heterogeneous vancomycin-intermediate Staphylococcus aureus: A preliminary report from south India

Rajesh Amberpet et al. Indian J Med Res. 2019 Aug.

Abstract

Background & objectives: Although there are reports of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) across the globe, there is a lack of reliable data on hVISA in India. The present study was undertaken to determine the rate of hVISA among the methicillin-resistant Staphylococcus aureus (MRSA) isolates, and to compare the brain heart infusion agar with vancomycin 4 μg/ml (BHIV4) method with population analysis profile-area under the curve (PAP-AUC) method for the detection of hVISA and to study the distribution of mobile genetic element that carries methicillin-resistance gene SCCmec (Staphylococcal cassette chromosome mec) types among these isolates.

Methods: BHIV4 and PAP-AUC methods were employed to detect hVISA among 500 clinical isolates of MRSA. SCCmec typing of these isolates was performed by multiplex polymerase chain reaction. The clinical presentation, treatment with vancomycin and outcome was documented for patients with hVISA.

Results: The rate of hVISA was 12.4 per cent by PAP-AUC method. Sensitivity, specificity, PPV, NPV and kappa agreement of BHIV4 with PAP-AUC was 58.06, 93.15, 54.55, 94.01 per cent and 0.498, respectively. The isolation of hVISA was significantly (P<0.01) higher in patients admitted to intensive care units and wards than in patients attending the outpatient departments. Only 38 per cent of the patients received vancomycin as therapy. Majority of the hVISA isolates carried SCCmec type V or IV.

Interpretation & conclusions: The rate of hVISA isolation in our study was 12.4 per cent. The sensitivity of the BHIV4 screening test was low, and was in moderate agreement with PAP-AUC test. SCCmec type V was the predominant type seen in half of the isolates. More studies need to be done in different parts of the country on a large number of isolates to confirm our findings.

Keywords: BHIV4; PAP method; SCC mec type; hVISA; mecA; methicillin-resistant Staphylococcus aureus; vancomycin.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None.

References

    1. Holmes NE, Johnson PDR, Howden BP. Relationship between vancomycin-resistant Staphylococcus aureus, vancomycin-intermediate S. aureus, high vancomycin MIC, and outcome in serious S. aureus infections. J Clin Microbiol. 2012;50:2548–52. - PMC - PubMed
    1. Howden BP, Davies JK, Johnson PDR, Stinear TP, Grayson ML. Reduced vancomycin susceptibility in Staphylococcus aureus, including vancomycin-intermediate and heterogeneous vancomycin-intermediate strains: Resistance mechanisms, laboratory detection, and clinical implications. Clin Microbiol Rev. 2010;23:99–139. - PMC - PubMed
    1. Singh A, Prasad KN, Misra R, Rahman M, Singh SK, Rai RP, et al. Increasing trend of heterogeneous vancomycin intermediate Staphylococcus aureus in a tertiary care center of Northern India. Microb Drug Resist. 2015;21:545–50. - PubMed
    1. Zhang S, Sun X, Chang W, Dai Y, Ma X. Systematic review and meta-analysis of the epidemiology of vancomycin-intermediate and heterogeneous vancomycin-intermediate Staphylococcus aureus isolates. PLoS One. 2015;10:e0136082. - PMC - PubMed
    1. Hu HC, Kao KC, Chiu LC, Chang CH, Hung CY, Li LF, et al. Clinical outcomes and molecular typing of heterogenous vancomycin-intermediate Staphylococcus aureus bacteremia in patients in intensive care units. BMC Infect Dis. 2015;15:444. - PMC - PubMed

MeSH terms