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JAC Advance Access originally published online on July 10, 2007
Journal of Antimicrobial Chemotherapy 2007 60(4):788-794; doi:10.1093/jac/dkm258
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Vancomycin MIC creep in non-vancomycin-intermediate Staphylococcus aureus (VISA), vancomycin-susceptible clinical methicillin-resistant S. aureus (MRSA) blood isolates from 2001–05

Gregory Steinkraus1,*, Roger White2 and Lawrence Friedrich3

1 New Hanover Regional Medical Center, 2131 South 17th Street, Wilmington, NC 28402, USA 2 Department of Pharmaceutical and Biomedical Sciences, Medical University of South Carolina, 280 Calhoun Street, Room QF 219, PO Box 250140, Charleston, SC 29425, USA 3 Cubist Pharmaceuticals, 804 Prince Ferry Lane, Mt. Pleasant, SC 29464, USA

Received 19 April 2007; returned 23 May 2007; revised 14 June 2007; accepted 20 June 2007

* Corresponding author. +1-910-343-7078; Fax: +1-901-343-7829; Email: gregory.steinkraus{at}nhhn.org

Objectives: To assess whether methicillin-resistant Staphylococcus aureus (MRSA) vancomycin MIC shifts (MIC creep) at a tertiary care institution occurred that may have gone undetected using traditional susceptibility markers (percentage susceptible, MIC50, MIC90) over a 5 year period. Additionally, MIC trends were evaluated for oxacillin, linezolid and daptomycin.

Methods: Etest MICs were performed on MRSA blood culture isolates (January 2001–December 2005). Only one isolate per patient was studied. The reported Etest MIC result was used and not rounded upward. MIC50, MIC90, median and geometric mean MIC, percentage susceptible and percentage resistant were calculated for each drug in each year. Non-parametric methods (linear correlation and Mantel–Haenszel {chi}2) were used to assess MIC trends over time and the association of vancomycin, linezolid and daptomycin MICs with oxacillin MICs.

Results: All isolates were susceptible to vancomycin, linezolid and daptomycin and resistant to oxacillin. MICs increased for vancomycin, linezolid and oxacillin (P < 0.0001); however, daptomycin MICs decreased slightly (P = 0.0386). For vancomycin, linezolid and oxacillin, there were significant increases (P < 0.0001) in the percentage of isolates with MICs that were higher than the respective 2001 median MIC, but not for daptomycin (P = 0.1361). Oxacillin MICs were associated with MICs of linezolid (r = 0.364, P < 0.0001), vancomycin (r = 0.353, P < 0.0001) and daptomycin (r = 0.106, P = 0.0063).

Conclusions: Oxacillin, vancomycin and linezolid MICs increased over time. For vancomycin and linezolid, these MIC increases were not reliably detected by percentage susceptibility as they occurred below the susceptibility breakpoint. Although the MICs of all agents appeared to be associated with increasing oxacillin MICs, the strongest associations were noted for vancomycin and linezolid.

Keywords: daptomycin , linezolid , susceptibility


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