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JAC Advance Access published online on July 26, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dki272
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org
Received March 17, 2005
Revised June 22, 2005
Accepted July 2, 2005

Original article

Methicillin-resistant Staphylococcus aureus heterogeneously resistant to vancomycin in a Turkish university hospital

Banu Sancak 1*, Serpil Ercis 1, Dilek Menemenlioglu 1, Sule Çolakoglu 1, and Gülsen Hasçelik 1

1 Department of Clinical Microbiology and Microbiology, Hacettepe University Medical School, Ankara, 06100, Turkey

* To whom correspondence should be addressed.
Banu Sancak, E-mail: banusancak{at}yahoo.com


  Abstract

Objectives: We investigated vancomycin-intermediate Staphylococcus aureus (VISA) and heterogeneously vancomycin-intermediate S. aureus (hetero-VISA) isolates from clinical specimens of hospitalized patients at Hacettepe University over a 4 year period.

Methods: Strains were screened for VISA and hetero-VISA by using brain heart infusion agar containing 4 mg/L vancomycin (BHI-V4) and macro Etest. Confirmation of the isolates that were found to have intermediate susceptibility to vancomycin with either of the methods was done by population analysis of subpopulations with reduced susceptibility to vancomycin. The MIC of vancomycin for the isolates grown on BHI-V4 was determined by the microdilution method.

Results: Among 256 methicillin-resistant S. aureus (MRSA) isolates, 145 grew on BHI-V4. Forty-six of these were also found to be heterogeneously vancomycin-intermediate strains when screened with the macro Etest. There were no VISA among 256 MRSA tested but 46 (17.97%) S. aureus strains with reduced susceptibility to vancomycin were identified by population analysis. Vancomycin MIC values for all isolates with reduced susceptibility were between ≤0.125 and 4 mg/L. Twelve of the 46 patients with hetero-VISA had a history of previously being treated with vancomycin or teicoplanin.

Conclusions: To our knowledge, this study is the first publication showing the presence of hetero-VISA in Turkey. In order to understand the epidemiological relationship between our isolates, molecular typing methods are needed.

Keywords: MRSA; hetero-VISA; VISA; S. aureus; Turkey.
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