Low colonization prevalence of Staphylococcus aureus with reduced vancomycin susceptibility among patients undergoing hemodialysis in the San Francisco Bay area.
Low colonization prevalence of Staphylococcus aureus with reduced vancomycin susceptibility among patients undergoing hemodialysis in the San Francisco Bay area.
复制标题
在旧金山湾区接受血液透析的患者中，金黄色葡萄球菌定植率较低，万古霉素敏感性降低。
DOI：
10.1086/429906
复制
发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Chambers,HenryF
中科院分区：
文献类型：
--
作者：
Eguia,JoseM;Liu,Catherine;Moore,Matthew;Wrone,ElizabethM;Pont,Joan;Gerberding,JulieL;Chambers,HenryF
金黄色葡萄球菌表现出不同程度的万古霉素敏感性降低，在接触这种抗生素的异质性耐药前体菌株中，通过对亚群进行抗生素选择，可以产生中等水平的耐药性菌株。我们试图确定携带潜在的异质万古霉素中间体的流行率和危险因素。我们前瞻性地观察了211名接受血液透析的患者，并进行了长达两年的季度监测培养。结果从7例患者中分离到10株甲氧西林敏感和耐甲氧西林的hVISA。金黄色葡萄球菌。没有确认确认的hVISA分离株；我们可以95%确定确认的hVISA携带率不超过1.4%。在单因素分析中，与未定植的血液透析患者相比，无论是万古霉素暴露、住院时间，还是任何基线的临床或人口学因素，都不能预测潜在的hVISA定植；在多因素分析中，接受血液透析的月数增加与潜在的hVISA定植相关。随着万古霉素敏感性的降低，携带这些分离物仍然是一种罕见的现象。鉴于潜在的hVISA的临床意义尚不清楚，临床实验室是否应该识别这种菌株，或者他们应该如何识别，目前还不清楚。
BackgroundStaphylococcus aureusexhibits 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-intermediateS. aureus(hVISA).MethodsWe 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.ResultsWe identified 10 colonizing potential hVISA isolates recovered from 7 patients among both methicillin-susceptible and methicillin-resistantS. aureusstrains. 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.ConclusionsDespite numerous published reports ofS. aureuswith 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.