Vancomycin-resistant Staphylococcus aureus

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Vancomycin-resistant Staphylococcus aureus
Other names: VRSA[1]
  • Top:a-d)Resistant mechanism of vancomycin-resistant Staphylococcus aureus[2]

  • Bottom: Timeline delineating the advent of antibiotic therapies and subsequent emergence of antibiotic-resistant S. aureus.[1]
SpecialtyInfectious disease
SymptomsSwelling from a wound[3]
ComplicationsBone infection, endocarditis[4]
Risk factorsDiabetes, kidney problems[5]
Diagnostic methodAutomated and non-automated susceptibility testing methods[5]
TreatmentCeftaroline, daptomycin, linezolid, minocyline, tigecycline, rifampin, and trimethoprim/sulfamethoxazole[2]
FrequencyVRSA, VISA, and hVISA prevalence reached 2.4%, 4.3%, and 5.3% (per 2020 Meta analysis)[6]

Vancomycin-resistant Staphylococcus aureus (VRSA) are strains of Staphylococcus aureus that have become resistant to the glycopeptide antibiotic vancomycin.[7]

This resistance can occur through random mutations or the transfer of DNA from one bacterium to another. VRSA is a significant concern because it limits the treatment options for infections due to these bacteria.[8][9]

Types

VISA, VRSA, and hVISA are related but distinct types of antibiotic resistance in Staphylococcus aureus. vancomycin-intermediate S. aureus (VISA), heterogeneous vancomycin-intermediate S. aureus (hVISA), and high-level vancomycin-resistant S. aureus (VRSA).[10]

Vancomycin-intermediate S. aureus (VISA)

Vancomycin-intermediate S. aureus (VISA) (/ˈviːsə/ or /viːaɪɛseɪ/) was first identified in Japan in 1996[11] and has since been found in hospitals elsewhere in Asia, as well as in the United Kingdom, France, the U.S., and Brazil. It is also termed GISA (glycopeptide-intermediate Staphylococcus aureus), indicating resistance to all glycopeptide antibiotics. These bacterial strains present a thickening of the cell wall, which is believed to reduce the ability of vancomycin to diffuse into the division septum of the cell required for effective vancomycin treatment.[12][13][14]

Vancomycin-resistant S. aureus (VRSA)

High-level vancomycin resistance in S. aureus has been rarely reported.[15] In vitro and in vivo experiments reported in 1992 demonstrated that vancomycin resistance genes from Enterococcus faecalis could be transferred by gene transfer to S. aureus, conferring high-level vancomycin resistance to S. aureus.[16] Until 2002 such a genetic transfer was not reported for wild S. aureus strains. In 2002, a VRSA strain (/ˈvɜːrsə/ or /viːɑːrɛseɪ/) was isolated from a patient in Michigan.[17] The isolate contained the mecA gene for methicillin resistance. Vancomycin MICs of the VRSA isolate were consistent with the VanA phenotype of Enterococcus species, and the presence of the vanA gene was confirmed by polymerase chain reaction. The DNA sequence of the VRSA vanA gene was identical to that of a vancomycin-resistant strain of Enterococcus faecalis recovered from the same catheter tip. The vanA gene was later found to be encoded within a transposon located on a plasmid carried by the VRSA isolate. This transposon, Tn1546, confers vanA-type vancomycin resistance in enterococci.[18][19][17]

Heterogeneous vancomycin-intermediate S. aureus (hVISA)

The definition of hVISA according to Hiramatsu et al. is a strain of Staphylococcus aureus that gives resistance to vancomycin at a frequency of 10−6 colonies or even higher.[20]

Signs and symptoms

In terms of the presentation of VRSA we find that it can cause skin conditions like pimples(or boils) and be red, inflamed, and/or warm .[3]

Bone infection

Complications

Among the complications an individual with VRSA may encounter are:[21][3]

Risk factors

Among the possible risk factors for VRSA are the following:[22]

Mechanism

Strains of hVISA and vancomycin-intermediate Staphylococcus aureus (VISA) do not have resistant genes found in Enterococcus and the proposed mechanisms of resistance include the sequential mutations resulting in a thicker cell wall and the synthesis of excess amounts of D-ala-D-ala residues.[23]

VRSA strain acquired the vancomycin resistance gene cluster vanA from VRE.[24]

Diagnosis

Evaluation for VRSA[25]

The diagnosis of vancomycin-resistant Staphylococcus aureus can be done with the following:[26][9][8]

  • Automated susceptibility testing
  • Non-automated susceptibility testing
  • Reference broth microdilution
  • Agar dilution
  • Gradient diffusion strips

Differential diagnosis

The DDx of VRSA in an infected individual is as follows:[27]

  • Methicillin-resistant Staphylococcus aureus
  • Other Gram-positive infections

Treatment

Rifampicin

For isolates with a vancomycin minimum inhibitory concentration (MIC) > 2 µg/mL, an alternative to vancomycin should be used.[28]

The approach is to treat with at least one agent to which VISA/VRSA is known to be susceptible by in vitro testing. The agents that are used include daptomycin, linezolid, telavancin, ceftaroline, quinupristin–dalfopristin. [28]

For people with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in the setting of vancomycin failure the IDSA recommends high-dose daptomycin, if the isolate is susceptible, in combination with another agent (e.g. gentamicin, rifampin, linezolid, TMP-SMX, or a beta-lactam antibiotic).[28]

Epidemiology

In terms of the epidemiology of VRSA we find cases have been reported in several countries, including Brazil, India, Iran, Pakistan, Portugal and United States.[29]

We find the prevalence of VRSA varies by region, for instance in Ethiopia it is around 14.52 percent. It can be interpreted as that the prevalence rates are higher in developing countries compared to developed ones, generally speaking[30]

The prevalence of vancomycin-resistant Staphylococcus aureus (VRSA) varies by region, and has been increasing in recent years:[6]

  • Number of VRSA, VISA and hVISA isolates in different continent[6]
    Number of VRSA, VISA and hVISA isolates in different continent[6]
  • Distribution of VRSA, VISA and hVISA isolates among different countries[6]
    Distribution of VRSA, VISA and hVISA isolates among different countries[6]

History

The CDC reported in the year 2002, the first case worldwide of VRSA in a 40 year old female from the state of Michigan in the U.S.[31]

See also

References

  1. ↑ 1.0 1.1 McGuinness, Will A.; Malachowa, Natalia; DeLeo, Frank R. (June 2017). "Vancomycin Resistance in Staphylococcus aureus". The Yale Journal of Biology and Medicine. 90 (2): 269–281. ISSN 1551-4056. Archived from the original on 2024-09-07. Retrieved 2024-10-26.
  2. ↑ 2.0 2.1 Cong, Yanguang; Yang, Sijin; Rao, Xiancai (12 October 2019). "Vancomycin resistant Staphylococcus aureus infections: A review of case updating and clinical features". Journal of Advanced Research. 21: 169–176. doi:10.1016/j.jare.2019.10.005. ISSN 2090-1232. Archived from the original on 1 August 2024. Retrieved 1 October 2024.
  3. ↑ 3.0 3.1 3.2 "Vancomycin-Intermediate/Resistant Staphylococcus aureus (VISA/VRSA) | Wisconsin Department of Health Services". www.dhs.wisconsin.gov. 1 October 2021. Archived from the original on 9 September 2024. Retrieved 9 October 2024.
  4. ↑ "VRSA". vdh.virginia.gov. Archived from the original on 2 October 2024. Retrieved 1 October 2024.
  5. ↑ 5.0 5.1 "About Vancomycin-resistant Staphylococcus aureus". Staphylococcus aureus. 9 July 2024. Archived from the original on 28 September 2024. Retrieved 1 October 2024.
  6. ↑ 6.0 6.1 6.2 6.3 Shariati, Aref; Dadashi, Masoud; Moghadam, Majid Taati; van Belkum, Alex; Yaslianifard, Somayeh; Darban-Sarokhalil, Davood (29 July 2020). "Global prevalence and distribution of vancomycin resistant, vancomycin intermediate and heterogeneously vancomycin intermediate Staphylococcus aureus clinical isolates: a systematic review and meta-analysis". Scientific Reports. 10 (1): 12689. doi:10.1038/s41598-020-69058-z. ISSN 2045-2322. Archived from the original on 2 October 2024. Retrieved 2 October 2024.
  7. ↑ "CDC - VISA / VRSA in Healthcare Settings - HAI". www.cdc.gov. Archived from the original on 2015-04-28. Retrieved 2015-06-11.
  8. ↑ 8.0 8.1 "VRSA" (PDF). cdc. Archived (PDF) from the original on 1 October 2024. Retrieved 5 October 2024.
  9. ↑ 9.0 9.1 "Laboratory Testing for Vancomycin-resistant Staphylococcus aureus". Staphylococcus aureus. 15 April 2024. Archived from the original on 27 September 2024. Retrieved 5 October 2024.
  10. ↑ Appelbaum PC (November 2007). "Reduced glycopeptide susceptibility in methicillin-resistant Staphylococcus aureus (MRSA)". Int. J. Antimicrob. Agents. 30 (5): 398–408. doi:10.1016/j.ijantimicag.2007.07.011. PMID 17888634.
  11. ↑ Hiramatsu, K.; Hanaki, H.; Ino, T.; Yabuta, K.; Oguri, T.; Tenover, F. C. (1997-07-01). "Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility". Journal of Antimicrobial Chemotherapy. 40 (1): 135–136. doi:10.1093/jac/40.1.135. ISSN 0305-7453. PMID 9249217.
  12. ↑ Howden BP, Davies JK, Johnson PD, Stinear TP, Grayson ML (Jan 2010). "Reduced vancomycin susceptibility in Staphylococcus aureus, including vancomycin-intermediate and heterogeneous vancomycin-intermediate strains: resistance mechanisms, laboratory detection, and clinical implications". Clin. Microbiol. Rev. 23 (1): 99–139. doi:10.1128/CMR.00042-09. PMC 2806658. PMID 20065327.
  13. ↑ Hiramatsu, Keiichi; Kayayama, Yuki; Matsuo, Miki; Aiba, Yoshifumi; Saito, Michie; Hishinuma, Tomomi; Iwamoto, Akira (December 2014). "Vancomycin-intermediate resistance in Staphylococcus aureus". Journal of Global Antimicrobial Resistance. 2 (4): 213–224. doi:10.1016/j.jgar.2014.04.006. ISSN 2213-7173. Archived from the original on 2024-10-06. Retrieved 2024-10-04.
  14. ↑ Hu, Qiwen; Peng, Huagang; Rao, Xiancai (13 October 2016). "Molecular Events for Promotion of Vancomycin Resistance in Vancomycin Intermediate Staphylococcus aureus". Frontiers in Microbiology. 7. doi:10.3389/fmicb.2016.01601. ISSN 1664-302X. Archived from the original on 9 June 2024. Retrieved 4 October 2024.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  15. ↑ Gould IM (December 2010). "VRSA-doomsday superbug or damp squib?". Lancet Infect Dis. 10 (12): 816–8. doi:10.1016/S1473-3099(10)70259-0. PMID 21109164.
  16. ↑ Proft, Thomas (2013). Bacterial Toxins: Genetics, Cellular Biology and Practical Applications. Horizon Scientific Press. ISBN 9781908230287. Archived from the original on 2021-12-11. Retrieved 2021-04-24.
  17. ↑ 17.0 17.1 Amábile-Cuevas, Carlos F. (2007). Antimicrobial Resistance in Bacteria. Horizon Scientific Press. ISBN 9781904933243.
  18. ↑ Courvalin P (January 2006). "Vancomycin resistance in gram-positive cocci". Clin. Infect. Dis. 42 Suppl 1: S25–34. doi:10.1086/491711. PMID 16323116.
  19. ↑ "Staphylococcus aureus Resistant to Vancomycin --- United States, 2002". www.cdc.gov. Archived from the original on 8 October 2024. Retrieved 6 October 2024.
  20. ↑ Lu, Yichen; Essex, Max; Roberts, Bryan (2008-04-11). Emerging Infections in Asia. Springer Science & Business Media. ISBN 9780387757216.
  21. ↑ Selim, Samy; Faried, Osama Ahmed; Almuhayawi, Mohammed S.; Saleh, Fayez M.; Sharaf, Mohamed; El Nahhas, Nihal; Warrad, Mona (18 March 2022). "Incidence of Vancomycin-Resistant Staphylococcus aureus Strains among Patients with Urinary Tract Infections". Antibiotics. 11 (3): 408. doi:10.3390/antibiotics11030408. ISSN 2079-6382. Archived from the original on 9 October 2024. Retrieved 7 October 2024.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  22. ↑ "Clinician Brief: Clinical Laboratories' and Infection Preventionists' Roles in the Search for and Containment of Vancomycin-Resistant Staphylococcus aureus". Staphylococcus aureus. 16 May 2024. Archived from the original on 28 September 2024. Retrieved 10 October 2024.
  23. ↑ Howden, Benjamin P.; Davies, John K.; Johnson, Paul D. R.; Stinear, Timothy P.; Grayson, M. Lindsay (2010-01-01). "Reduced Vancomycin Susceptibility in Staphylococcus aureus, Including Vancomycin-Intermediate and Heterogeneous Vancomycin-Intermediate Strains: Resistance Mechanisms, Laboratory Detection, and Clinical Implications". Clinical Microbiology Reviews. 23 (1): 99–139. doi:10.1128/CMR.00042-09. ISSN 0893-8512. PMC 2806658. PMID 20065327.
  24. ↑ Chang, Soju; Sievert, Dawn M.; Hageman, Jeffrey C.; Boulton, Matthew L.; Tenover, Fred C.; Downes, Frances Pouch; Shah, Sandip; Rudrik, James T.; Pupp, Guy R. (2003-04-03). "Infection with Vancomycin-Resistant Staphylococcus aureus Containing the vanA Resistance Gene". New England Journal of Medicine. 348 (14): 1342–1347. doi:10.1056/NEJMoa025025. ISSN 0028-4793. PMID 12672861.
  25. ↑ "Vancomycin-Resistant Staphylococcus aureus" (PDF). Utah Department of health. Retrieved 27 September 2024.
  26. ↑ Loomba, Poonam Sood; Taneja, Juhi; Mishra, Bibhabati (2010-01-01). "Methicillin and Vancomycin Resistant S. aureus in Hospitalized Patients". Journal of Global Infectious Diseases. 2 (3): 275–283. doi:10.4103/0974-777X.68535. ISSN 0974-777X. PMC 2946685. PMID 20927290.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  27. ↑ Weinstein, R. A.; Fridkin, S. K. (1 January 2001). "Vancomycin-Intermediate and -Resistant Staphylococcus aureus: What the Infectious Disease Specialist Needs to Know". Clinical Infectious Diseases. 32 (1): 108–115. doi:10.1086/317542. Archived from the original on 23 June 2022. Retrieved 10 October 2024.
  28. ↑ 28.0 28.1 28.2 Liu, Catherine; et al. (2011). "Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children". Clinical Infectious Diseases. 52 (3): e18 – e55. doi:10.1093/cid/ciq146. PMID 21208910.
  29. ↑ Blechman, Samuel E.; Wright, Erik S. (29 August 2024). "Vancomycin-resistant Staphylococcus aureus (VRSA) can overcome the cost of antibiotic resistance and may threaten vancomycin's clinical durability". PLOS Pathogens. 20 (8): e1012422. doi:10.1371/journal.ppat.1012422. ISSN 1553-7374. Archived from the original on 20 September 2024. Retrieved 24 September 2024.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  30. ↑ Belete, Melaku Ashagrie; Gedefie, Alemu; Alemayehu, Ermiyas; Debash, Habtu; Mohammed, Ousman; Gebretsadik, Daniel; Ebrahim, Hussen; Tilahun, Mihret (30 August 2023). "The prevalence of vancomycin-resistant Staphylococcus aureus in Ethiopia: a systematic review and meta-analysis". Antimicrobial Resistance & Infection Control. 12 (1): 86. doi:10.1186/s13756-023-01291-3. ISSN 2047-2994.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  31. ↑ Gottlieb, Scott (12 April 2003). "CDC reports first case of vancomycin resistant Staphylococcus aureus". BMJ. p. 783. doi:10.1136/bmj.326.7393.783/a. Archived from the original on 2 October 2024. Retrieved 2 October 2024.

Further reading

  • Chang, Soju; Sievert, Dawn M.; Hageman, Jeffrey C.; Boulton, Matthew L.; Tenover, Fred C.; Downes, Frances Pouch; Shah, Sandip; Rudrik, James T.; Pupp, Guy R. (April 3, 2003). "Infection with Vancomycin-Resistant Staphylococcus aureus Containing the vanA Resistance Gene". New England Journal of Medicine. 348 (14): 1342–1347. doi:10.1056/NEJMoa025025. ISSN 0028-4793. PMID 12672861.

External links

Classification
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