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MRSA isolates with vancomycin MIC = 2mg/L were screened for hVISA, using BHI agar with 4mg/L of vancomycin and 16g/L of pancreatic digest of casein (Merck, Darmstadt, Germany) (BHI4ca), and Etest[R] (bioMerieux) macromethod.
The similar studies also conducted in different parts of the world and reported VISA, hVISA and VRSA strains11-13.
Four (9.75%) MRSA isolates were confirmed as hVISA by E test GRD.The frequency of hVISA among MRSA isolates was higher in blood specimens (66.6%) followed by pus (7.69%).
While the genetic determinants of hVISA and VISA are partially understood, the relative contributions of these mutations--and of altered cellular processes that contribute to hVISA and VISA--in determining the vancomycin MIC are unknown.
hVISA and MRSA endocarditis: an 8-year experience in a tertiary care centre.
In general, hVISA express a low-level vancomycin resistance, yet upon exposure to vancomycin, these strains produce select VISA cell subpopulations .
It's difficult to determine how common hVISA is because different groups use different criteria to define and detect hVISA, said Dr.
Daptomycin is an alternative to vancomycin for patients with MRSA infections, but some authors have recommended to use high doses to minimize the emergence of elevated MIC values, which has been associated with an increase in the vancomycin MIC and the heteroresistant phenotype (hVISA).
We sent some isolates--8 (15%) VISA strains, 88 (15%) non-VISA strains, and 10 VISA control strains (from the Network on Antimicrobial Resistance in Staphylococcus aureus, www.narsa.net)--to an outside laboratory for blinded testing by using the Vitek 2 (bioMerieux, Durham, NC, USA) with the AST-GP-67 card, and we sent 8 (15%) hVISA isolates to an outside laboratory for retesting by using time-killing profiles.
Infection with VISA appears to be preceded by a subclinical state known as heterogenous VISA (hVISA), which refers to strains of S.
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