Journal Article

Bacteremia Caused by Staphylococci with Inducible Vancomycin Heteroresistance

Samson S. Y. Wong, P. L. Ho, Patrick C. Y. Woo and K. Y. Yuen

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 29, issue 4, pages 760-767
Published in print August 1999 | ISSN: 1058-4838
Published online August 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/520429
Bacteremia Caused by Staphylococci with Inducible Vancomycin Heteroresistance

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The clinical significance of bacteremia due to vancomycin-heteroresistant staphylococci and a rapid laboratory screening method were examined; 203 strains of staphylococci isolated from patients with clinically significant bacteremia were screened by the disk-agar method with use of vancomycin-salt agar to demonstrate satellitism around an aztreonam disk as well as by conventional population screening. Eighteen isolates (three Staphylococcus aureus and 15 coagulasenegative staphylococci) were shown to be heteroresistant to vancomycin. A case-control clinical study showed that the interval between admission and bacteremia, admission to the intensive care unit, prior use of vancomycin and/or β-lactams, and isolation of methicillin-resistant staphylococci were significantly more common among patients with bacteremia due to staphylococci with heteroresistance to vancomycin; these patients had an overall mortality of 44.4%. The use of vancomycin and admission to the intensive care unit were independently significant risk factors on multivariate analysis. Vancomycin heteroresistance is inducible by salt and β-lactams. Indiscriminate sequential use of β-lactams and glycopeptides may facilitate the emergence of glycopeptide resistance.

Journal Article.  0 words. 

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

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