Reduced Vancomycin Susceptibility inStaphylococcus aureus, Including Vancomycin-Intermediate and Heterogeneous Vancomycin-Intermediate Strains: Resistance Mechanisms, Laboratory Detection, and Clinical Implications

Clinical Microbiology Reviews - Tập 23 Số 1 - Trang 99-139 - 2010
Benjamin P. Howden1,2,3,4, John K. Davies2, Paul D. R. Johnson1,2,3, Timothy P. Stinear1,2, M Lindsay Grayson5,6,3
1Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria, Australia
2Department of Microbiology, Monash University, Wellington Rd, Clayton, Victoria, Australia
3Departments of Infectious Diseases
4Microbiology, Austin Health, Heidelberg, Victoria, Australia
5Department of Epidemiology and Preventive Medicine, Monash University, Wellington Rd., Clayton, Victoria, Australia
6Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia

Tóm tắt

SUMMARY

The emergence of vancomycin-intermediateStaphylococcus aureus(VISA) and heterogeneous vancomycin-intermediateStaphylococcus aureus(hVISA) over the past decade has provided a challenge to diagnostic microbiologists to detect these strains, clinicians treating patients with infections due to these strains, and researchers attempting to understand the resistance mechanisms. Recent data show that these strains have been detected globally and in many cases are associated with glycopeptide treatment failure; however, more rigorous clinical studies are required to clearly define the contribution of hVISA to glycopeptide treatment outcomes. It is now becoming clear that sequential point mutations in key global regulatory genes contribute to the hVISA and VISA phenotypes, which are associated predominately with cell wall thickening and restricted vancomycin access to its site of activity in the division septum; however, the phenotypic features of these strains can vary because the mutations leading to resistance can vary. Interestingly, changes in the staphylococcal surface and expression ofagrare likely to impact host-pathogen interactions in hVISA and VISA infections. Given the subtleties of vancomycin susceptibility testing againstS. aureus, it is imperative that diagnostic laboratories use well-standardized methods and have a framework for detecting reduced vancomycin susceptibility inS. aureus.

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