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Title: Reduced vancomycin susceptibility in Staphylococcus aureus, including vancomycin-intermediate and heterogeneous vancomycin-intermediate strains: resistance mechanisms, laboratory detection, and clinical implications.
Austin Authors: Howden, Benjamin P ;Davies, John K;Johnson, Paul D R ;Stinear, Timothy P;Grayson, M Lindsay 
Affiliation: Infectious Diseases
Issue Date: 1-Jan-2010
Publication information: Clinical Microbiology Reviews; 23(1): 99-139
Abstract: The emergence of vancomycin-intermediate Staphylococcus aureus (VISA) and heterogeneous vancomycin-intermediate Staphylococcus 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 of agr are likely to impact host-pathogen interactions in hVISA and VISA infections. Given the subtleties of vancomycin susceptibility testing against S. aureus, it is imperative that diagnostic laboratories use well-standardized methods and have a framework for detecting reduced vancomycin susceptibility in S. aureus.
DOI: 10.1128/CMR.00042-09
Journal: Clinical Microbiology Reviews
Type: Journal Article
Subjects: Anti-Bacterial Agents.pharmacology.therapeutic use
Microbial Sensitivity Tests
Staphylococcal Infections.drug therapy.microbiology
Staphylococcus aureus.drug effects
Treatment Outcome
Vancomycin.pharmacology.therapeutic use
Vancomycin Resistance
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