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Heterogeneous vancomycin-intermediate Staphylococcus aureus (HVISA) at a tertiary hospital in Malaysia

Methicillin-resistant Staphylococcus aureus remains a global problem. The emergence of reduced susceptibility to Vancomycin in MRSA strains, leads to treatment failure and prolonged hospital stay. Therefore, we aimed to determine the strains with reduced susceptibility among MRSA clinical isolates....

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Main Authors:	Hamasalih, Bakhtiyar Mahmood, Neoh, Hui-min, Rosni Ibrahim,, Lailatul Akmar Mat Nor,, Tengku Zetty Maztura Tengku Jamaluddin,
Format:	Article
Language:	English
Published:	Penerbit Universiti Kebangsaan Malaysia 2022
Online Access:	http://journalarticle.ukm.my/19164/1/13.pdf http://journalarticle.ukm.my/19164/ https://www.ukm.my/jsm/malay_journals/jilid51bil3_2022/KandunganJilid51Bil3_2022.html
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spelling	my-ukm.journal.191642022-08-01T04:17:27Z http://journalarticle.ukm.my/19164/ Heterogeneous vancomycin-intermediate Staphylococcus aureus (HVISA) at a tertiary hospital in Malaysia Hamasalih, Bakhtiyar Mahmood Neoh, Hui-min Rosni Ibrahim, Lailatul Akmar Mat Nor, Tengku Zetty Maztura Tengku Jamaluddin, Methicillin-resistant Staphylococcus aureus remains a global problem. The emergence of reduced susceptibility to Vancomycin in MRSA strains, leads to treatment failure and prolonged hospital stay. Therefore, we aimed to determine the strains with reduced susceptibility among MRSA clinical isolates. S. aureus isolates were collected from identified clinical samples. Antibiotic susceptibility was tested using the Kirby-Bauer method. MRSA strains were confirmed using PCR for mecA gene and subjected to the Epsilometer test (Etest®) for determination of Vancomycin minimum inhibitory concentration (MIC). Isolates with intermediate or reduced susceptibility were subjected to broth microdilution (BMD) and further confirmed by population analysis-area under curve (PAP-AUC) testing. Disc diffusion tests showed that all isolates (n = 105; 100%) were susceptible to Rifampicin, followed by Trimethoprim/Sulfamethoxazole. Meanwhile, a high resistance rate was demonstrated against Penicillin (n = 93; 88.6%). Among all isolates, only 26.0% (n = 27) were MRSA. According to the Vancomycin MIC value by Etest®, only two strains (A3, A106) had intermediate susceptibility, and one strain (A30) had reduced susceptibility to Vancomycin (MIC 3 μg/mL). No susceptibility to Vancomycin was identified among strains using the BMD method. According to the PAP-AUC method, it was confirmed that strain A3 was a heterogeneous VISA strain. Vancomycin Etest®, is a reliable screening test for VISA detection. Vancomycin BMD result was not in agreement with the Vancomycin Etest® result. PAP-AUC, the gold standard test used to detect Vancomycin resistance, should be conducted whenever possible for further confirmation and epidemiological record. Penerbit Universiti Kebangsaan Malaysia 2022-03 Article PeerReviewed application/pdf en http://journalarticle.ukm.my/19164/1/13.pdf Hamasalih, Bakhtiyar Mahmood and Neoh, Hui-min and Rosni Ibrahim, and Lailatul Akmar Mat Nor, and Tengku Zetty Maztura Tengku Jamaluddin, (2022) Heterogeneous vancomycin-intermediate Staphylococcus aureus (HVISA) at a tertiary hospital in Malaysia. Sains Malaysiana, 51 (3). pp. 795-801. ISSN 0126-6039 https://www.ukm.my/jsm/malay_journals/jilid51bil3_2022/KandunganJilid51Bil3_2022.html
institution	Universiti Kebangsaan Malaysia
building	Tun Sri Lanang Library
collection	Institutional Repository
continent	Asia
country	Malaysia
content_provider	Universiti Kebangsaan Malaysia
content_source	UKM Journal Article Repository
url_provider	http://journalarticle.ukm.my/
language	English
description	Methicillin-resistant Staphylococcus aureus remains a global problem. The emergence of reduced susceptibility to Vancomycin in MRSA strains, leads to treatment failure and prolonged hospital stay. Therefore, we aimed to determine the strains with reduced susceptibility among MRSA clinical isolates. S. aureus isolates were collected from identified clinical samples. Antibiotic susceptibility was tested using the Kirby-Bauer method. MRSA strains were confirmed using PCR for mecA gene and subjected to the Epsilometer test (Etest®) for determination of Vancomycin minimum inhibitory concentration (MIC). Isolates with intermediate or reduced susceptibility were subjected to broth microdilution (BMD) and further confirmed by population analysis-area under curve (PAP-AUC) testing. Disc diffusion tests showed that all isolates (n = 105; 100%) were susceptible to Rifampicin, followed by Trimethoprim/Sulfamethoxazole. Meanwhile, a high resistance rate was demonstrated against Penicillin (n = 93; 88.6%). Among all isolates, only 26.0% (n = 27) were MRSA. According to the Vancomycin MIC value by Etest®, only two strains (A3, A106) had intermediate susceptibility, and one strain (A30) had reduced susceptibility to Vancomycin (MIC 3 μg/mL). No susceptibility to Vancomycin was identified among strains using the BMD method. According to the PAP-AUC method, it was confirmed that strain A3 was a heterogeneous VISA strain. Vancomycin Etest®, is a reliable screening test for VISA detection. Vancomycin BMD result was not in agreement with the Vancomycin Etest® result. PAP-AUC, the gold standard test used to detect Vancomycin resistance, should be conducted whenever possible for further confirmation and epidemiological record.
format	Article
author	Hamasalih, Bakhtiyar Mahmood Neoh, Hui-min Rosni Ibrahim, Lailatul Akmar Mat Nor, Tengku Zetty Maztura Tengku Jamaluddin,
spellingShingle	Hamasalih, Bakhtiyar Mahmood Neoh, Hui-min Rosni Ibrahim, Lailatul Akmar Mat Nor, Tengku Zetty Maztura Tengku Jamaluddin, Heterogeneous vancomycin-intermediate Staphylococcus aureus (HVISA) at a tertiary hospital in Malaysia
author_facet	Hamasalih, Bakhtiyar Mahmood Neoh, Hui-min Rosni Ibrahim, Lailatul Akmar Mat Nor, Tengku Zetty Maztura Tengku Jamaluddin,
author_sort	Hamasalih, Bakhtiyar Mahmood
title	Heterogeneous vancomycin-intermediate Staphylococcus aureus (HVISA) at a tertiary hospital in Malaysia
title_short	Heterogeneous vancomycin-intermediate Staphylococcus aureus (HVISA) at a tertiary hospital in Malaysia
title_full	Heterogeneous vancomycin-intermediate Staphylococcus aureus (HVISA) at a tertiary hospital in Malaysia
title_fullStr	Heterogeneous vancomycin-intermediate Staphylococcus aureus (HVISA) at a tertiary hospital in Malaysia
title_full_unstemmed	Heterogeneous vancomycin-intermediate Staphylococcus aureus (HVISA) at a tertiary hospital in Malaysia
title_sort	heterogeneous vancomycin-intermediate staphylococcus aureus (hvisa) at a tertiary hospital in malaysia
publisher	Penerbit Universiti Kebangsaan Malaysia
publishDate	2022
url	http://journalarticle.ukm.my/19164/1/13.pdf http://journalarticle.ukm.my/19164/ https://www.ukm.my/jsm/malay_journals/jilid51bil3_2022/KandunganJilid51Bil3_2022.html
_version_	1740826819307765760
score	13.211869

Heterogeneous vancomycin-intermediate Staphylococcus aureus (HVISA) at a tertiary hospital in Malaysia

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