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Chapter 5.7 : Detection of VRSA, VISA, and Vancomycin-Heteroresistant (hVISA)

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Detection of VRSA, VISA, and Vancomycin-Heteroresistant (hVISA), Page 1 of 2

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Abstract:

Vancomycin-resistant (VRSA) and vancomycin-intermediate (VISA) can be detected using routine broth microdilution methods (BMD) ( procedure 5.2) and by the vancomycin agar screen ( Table 5.7–1 ). Disk diffusion testing of vancomycin is not a reliable method to distinguish vancomycin-susceptible from VISA, nor can it reliably detect VRSA isolates with MICs ≤16 μg/ml ( ). Therefore, detection of VISA and VRSA isolates should preferentially be performed by BMD, agar dilution, or Etest methods ( ). For details, see Table 5.7–1 .

Citation: Leber A. 2016. Detection of VRSA, VISA, and Vancomycin-Heteroresistant (hVISA), p 5.7.1-5.7.9. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.7
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Figures

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Figure 5.7–A1

Test isolates versus Mu3 reference strain.

Citation: Leber A. 2016. Detection of VRSA, VISA, and Vancomycin-Heteroresistant (hVISA), p 5.7.1-5.7.9. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.7
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References

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1. CLSI. 2015. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-fifth Informational Supplement. CLSI document M100-S25. CLSI, Wayne, PA.
2. CLSI. 2015. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically; Approved Standard - Tenth Edition. CLSI document M07-A10. CLSI, Wayne, PA.
3. Tenover FC, Moellering RC. 2007. The rationale for revising the Clinical and Laboratory Standards Institute vancomycin minimal inhibitory concentration interpretive criteria for Staphylococcus aureus. Clin Infect Dis 44:12081215.
4. Ariza J, Pujol M, Cabo J, Peña C, Fernández N, Liñares J, Ayats J, Gudiol F. 1999. Vancomycin in surgical infections due to methicillin-resistant Staphylococcus aureus with heterogeneous resistance to vancomycin. Lancet 353:15871588.
5. Howe RA, Wootton M, Bennett PM, MacGowan AP, Walsh TR. 1999. Interactions between methicillin and vancomycin in methicillin-resistant Staphylococcus aureus strains displaying different phenotypes of vancomycin susceptibility. J Clin Microbiol 37:30683071.
6. Wootton M, Howe RA, Hillman R, Walsh TR, Bennett PM, MacGowan AP. 2001. A modified population analysis profile (PAP) method to detect hetero-resistance to vancomycin in Staphylococcus aureus in a UK hospital. J Antimicrob Chemother 47:399403.
7. Walsh TR, Bolmström A, Qwärnström A, Ho P, Wootton M, Howe RA, MacGowan AP, Diekema D. 2001. Evaluation of current methods for detection of staphylococci with reduced susceptibility to glycopeptides. J Clin Microbiol 39:24392444.
8. Hiramatsu K, Aritaka N, Hanaki H, Kawasaki S, Hosoda Y, Hori S, Fukuchi Y, Kobayashi I. 1997. Dissemination in Japanese hospitals of strains of Staphylococcus aureus heterogeneously resistant to vancomycin. Lancet 350:16701673.
9. Nunes AP, Teixeira LM, Iorio NL, Bastos CC, de Sousa Fonseca L, Souto-Padrón T, dos Santos KR. 2006. Heterogeneous resistance to vancomycin in Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus warneri clinical strains: characterisation of glycopeptide susceptibility profiles and cell wall thickening. Int J Antimicrob Agents 27:307315.
10. For detailed PAP-AUC:
11. Hiramatsu K, Aritaka N, Hanaki H, Kawasaki S, Hosoda Y, Hori S, Fukuchi Y, Kobayashi I. 1997. Dissemination in Japanese hospitals of strains of Staphylococcus aureus heterogeneously resistant to vancomycin. Lancet 350:16701673.
12. Nunes AP, Teixeira LM, Iorio NL, Bastos CC, de Sousa Fonseca L, Souto-Padrón T, dos Santos KR. 2006. Heterogeneous resistance to vancomycin in Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus warneri clinical strains: characterisation of glycopeptide susceptibility profiles and cell wall thickening. Int J Antimicrob Agents 27:307315.
13. For Modified PAP-AUC:
14. Wootton M, Howe RA, Hillman R, Walsh TR, Bennett PM, MacGowan AP. 2001. A modified population analysis profile (PAP) method to detect hetero-resistance to vancomycin in Staphylococcus aureus in a UK hospital. J Antimicrob Chemother 47:399403.
1. CLSI. 2012. Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved standard Eleventh Edition. CLSI M02-A11. Wayne, PA.
2. CLSI. 2015. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically; Approved Standard – Tenth Edition. CLSI M07-A10. CLSI, Wayne, PA.
3. CLSI. 2015. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-fifth Informational Supplement. CLSI M100-S25. CLSI, Wayne, PA.
4. AB BIODISK [Package inserts, vancomycin, teicoplanin, GRD]. 2008. bioMérieux, Inc., Durham, NC.
5. Wootton M, Howe RA, Hillman R, Walsh TR, Bennett PM, MacGowan AP. 2001. A modified population analysis profile (PAP) method to detect hetero-resistance to vancomycin in Staphylococcus aureus in a UK hospital. J Antimicrob Chemother 47:399403.
6. Yusof A, Engelhardt A, Karlsson A, Bylund L, Vidh P, Mills K, Wootton M, Walsh TR. 2008. Evaluation of a new Etest vancomycinteicoplanin strip for detection of glycopeptide-intermediate Staphylococcus aureus (GISA), in particular, heterogeneous GISA. J Clin Microbiol 46:30423047.

Tables

Generic image for table
Table 5.7–1

Summary of test methods for detection of hVISA, VISA, and VRSA in

Citation: Leber A. 2016. Detection of VRSA, VISA, and Vancomycin-Heteroresistant (hVISA), p 5.7.1-5.7.9. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.7
Generic image for table
Untitled

Citation: Leber A. 2016. Detection of VRSA, VISA, and Vancomycin-Heteroresistant (hVISA), p 5.7.1-5.7.9. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.7
Generic image for table
Preparation of vancomycin (VAN) dilutionsa

Preparation of vancomycin (VAN) dilutions

Citation: Leber A. 2016. Detection of VRSA, VISA, and Vancomycin-Heteroresistant (hVISA), p 5.7.1-5.7.9. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.7
Generic image for table
Volumes of components required for preparation of vancomycin agar plates when using 100 mm round petri plates

Volumes of components required for preparation of vancomycin agar plates when using 100 mm round petri plates

Citation: Leber A. 2016. Detection of VRSA, VISA, and Vancomycin-Heteroresistant (hVISA), p 5.7.1-5.7.9. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.7
Generic image for table
Untitled

Citation: Leber A. 2016. Detection of VRSA, VISA, and Vancomycin-Heteroresistant (hVISA), p 5.7.1-5.7.9. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.7
Generic image for table
Interpretation of results for test isolates

Interpretation of results for test isolates

Citation: Leber A. 2016. Detection of VRSA, VISA, and Vancomycin-Heteroresistant (hVISA), p 5.7.1-5.7.9. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.7
Generic image for table
PAP-AUC Worksheet

PAP-AUC Worksheet

Citation: Leber A. 2016. Detection of VRSA, VISA, and Vancomycin-Heteroresistant (hVISA), p 5.7.1-5.7.9. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.7

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