Heterogeneous Vancomycin-Intermediate Susceptibility Phenotype in Bloodstream Methicillin-Resistant Staphylococcus aureus Isolates from an International Cohort of Patients with Infective Endocarditis: Prevalence, Genotype, and Clinical Significance
Heterogeneous Vancomycin-Intermediate Susceptibility Phenotype in Bloodstream Methicillin-Resistant Staphylococcus aureus Isolates from an International Cohort of Patients with Infective Endocarditis: Prevalence, Genotype, and Clinical Significance
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DOI：
10.1086/606027
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发表时间：
2009-11-01
影响因子：
6.4
通讯作者：
Fowler, Vance G., Jr.
中科院分区：
文献类型：
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作者：
Bae, In-Gyu;Federspiel, Jerome J.;Fowler, Vance G., Jr.
背景异质性万古霉素中间金黄色葡萄球菌（hVISA）的意义尚不清楚。使用来自多个国家的耐甲氧西林S。金黄色葡萄球菌（MRSA）感染性心内膜炎（IE），我们的特点与IE患者和无hVISA，我们基因型的感染菌株。来自8个国家的65例确诊IE患者的MRSA血流分离株进行了31个毒力基因的聚合酶链反应（PCR）、脉冲场凝胶电泳和多位点序列分型。hVISA的定义使用人口分析轮廓。19（29.2%）的65株MRSA IE分离株显示hVISA表型的群体分析。来自大洋洲和欧洲的分离株比来自美国的分离株更可能表现出hVISA表型（77.8%和35.0% vs 13.9%; P <0.001）。万古霉素最低抑菌浓度为2 mg/L的分离株中hVISA的患病率较高（P = .026）。hVISA感染的患者更容易出现持续性菌血症（68.4% vs 37.0%; P = 0.029）和心力衰竭（47.4% vs 19.6%; P = 0.033）。hVISA感染和非hVISA感染患者的死亡率无差异（42.1% vs 34.8%，P = 0.586）。hVISA和非hVISA分离株的基因型相似。在这些分析中，hVISA表型出现在超过四分之一的MRSA IE分离株中，与某些IE并发症相关，并且频率因地理区域而异。
Background. The significance of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) is unknown. Using a multinational collection of isolates from methicillin-resistant S. aureus (MRSA) infective endocarditis (IE), we characterized patients with IE with and without hVISA, and we genotyped the infecting strains.Methods. MRSA bloodstream isolates from 65 patients with definite IE from 8 countries underwent polymerase chain reaction (PCR) for 31 virulence genes, pulsed-field gel electrophoresis, and multilocus sequence typing. hVISA was defined using population analysis profiling.Results. Nineteen (29.2%) of 65 MRSA IE isolates exhibited the hVISA phenotype by population analysis profiling. Isolates from Oceania and Europe were more likely to exhibit the hVISA phenotype than isolates from the United States (77.8% and 35.0% vs 13.9%; P < .001). The prevalence of hVISA was higher among isolates with a vancomycin minimum inhibitory concentration of 2 mg/L (P = .026). hVISA-infected patients were more likely to have persistent bacteremia (68.4% vs 37.0%; P = .029) and heart failure (47.4% vs 19.6%; P = .033). Mortality did not differ between hVISA- and non-hVISA-infected patients (42.1% vs 34.8%, P = .586). hVISA and non-hVISA isolates were genotypically similar.Conclusions. In these analyses, the hVISA phenotype occurred in more than one-quarter of MRSA IE isolates, was associated with certain IE complications, and varied in frequency by geographic region.