Journal Article

Analysis of 42 Cases of Septicemia Caused by an Epidemic Strain of Methicillin-Resistant <i>Staphylococcus aureus:</i> Evidence of Resistance to Vancomycin

James Burnie, Ruth Matthews, Asif Jiman-Fatami, Priscilla Gottardello, Samantha Hodgetts and Stuart D'arcy

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 31, issue 3, pages 684-689
Published in print September 2000 | ISSN: 1058-4838
Published online September 2000 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/314035
Analysis of 42 Cases of Septicemia Caused by an Epidemic Strain of Methicillin-Resistant Staphylococcus aureus: Evidence of Resistance to Vancomycin

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Recent case reports of vancomycin treatment failures in the United States, Japan, and France have prompted a retrospective analysis of 42 cases of septicemia caused by epidemic methicillin-resistant Stapyhlococcus aureus strain 15 (EMRSA-15), which is the most prevalent epidemic strain of methicillin-resistant S. aureus in the United Kingdom; all cases occurred in a teaching hospital in Manchester, United Kingdom, between 1994 and 1998. Mortality was lowest (4%) in patients with rifampin-susceptible isolates treated with vancomycin and rifampin. It rose to 38% in patients who were treated with both antibiotics but in whom the organism became resistant to rifampin during therapy, and it reached 78% in patients who had rifampin-resistant isolates or in whom rifampin was contraindicated (P < .0001; Fisher exact test, 2-tailed). All isolates were susceptible to vancomycin by conventional laboratory testing, but susceptibility was lost by growth in vancomycin in vitro, becoming resistant at a minimum inhibitory concentration of 8 mg/L. This was associated with accumulation of cell-wall material. The deoxyribonucleic acid fingerprint remained unchanged. This study suggests that rifampin played a key role in the prevention of deaths caused by an epidemic strain of methicillin-resistant S. aureus that readily gave rise to a subpopulation with reduced susceptibility to vancomycin.

Journal Article.  2972 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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