Journal Article

Low Colonization Prevalence of <i>Staphylococcus aureus</i> with Reduced Vancomycin Susceptibility among Patients Undergoing Hemodialysis in the San Francisco Bay Area

José M. Eguía, Catherine Liu, Matthew Moore, Elizabeth M. Wrone, Joan Pont, Julie L. Gerberding and Henry F. Chambers

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 40, issue 11, pages 1617-1624
Published in print June 2005 | ISSN: 1058-4838
Published online June 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/429906
Low Colonization Prevalence of Staphylococcus aureus with Reduced Vancomycin Susceptibility among Patients Undergoing Hemodialysis in the San Francisco Bay Area

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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 µg/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.

Journal Article.  4926 words.  Illustrated.

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

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