Skip to main content
PMC home page
Emerging Infectious Diseases logoLink to Emerging Infectious Diseases
. 2001 Mar-Apr;7(2):327–332. doi: 10.3201/eid0702.010237

Increasing resistance to vancomycin and other glycopeptides in Staphylococcus aureus.

F C Tenover 1, J W Biddle 1, M V Lancaster 1
PMCID: PMC2631729  PMID: 11294734

Abstract

Strains of Staphylococcus aureus with reduced susceptibility to glycopeptides have been reported from Japan, the United States, Europe, and the Far East. Although isolates with homogeneous resistance to vancomycin (MICs = 8 microg/mL) continue to be rare, there are increasing reports of strains showing heteroresistance, often with vancomycin MICs in the 1-4 microg/mL range. Most isolates with reduced susceptibility to vancomycin appear to have developed from preexisting methicillin-resistant S. aureus infections. Many of the isolates with reduced susceptibility to glycopeptides have been associated with therapeutic failures with vancomycin. Although nosocomial spread of the vancomycin-intermediate S. aureus (VISA) strains has not been observed in U.S. hospitals, spread of VISA strains has apparently occurred in Japan. Broth microdilution tests held a full 24 hours are optimal for detecting resistance in the laboratory; however, methods for detecting heteroresistant strains are still in flux. Disk-diffusion tests, including the Stokes method, do not detect VISA strains. The Centers for Disease Control and Prevention and other groups have issued recommendations regarding appropriate infection control procedures for patients infected with these strains.

Full Text

The Full Text of this article is available as a PDF (81.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ariza J., Pujol M., Cabo J., Peña C., Fernández N., Liñares J., Ayats J., Gudiol F. Vancomycin in surgical infections due to methicillin-resistant Staphylococcus aureus with heterogeneous resistance to vancomycin. Lancet. 1999 May 8;353(9164):1587–1588. doi: 10.1016/s0140-6736(99)01017-x. [DOI] [PubMed] [Google Scholar]
  2. Bierbaum G., Fuchs K., Lenz W., Szekat C., Sahl H. G. Presence of Staphylococcus aureus with reduced susceptibility to vancomycin in Germany. Eur J Clin Microbiol Infect Dis. 1999 Oct;18(10):691–696. doi: 10.1007/s100960050380. [DOI] [PubMed] [Google Scholar]
  3. Boyle-Vavra S., Berke S. K., Lee J. C., Daum R. S. Reversion of the glycopeptide resistance phenotype in Staphylococcus aureus clinical isolates. Antimicrob Agents Chemother. 2000 Feb;44(2):272–277. doi: 10.1128/aac.44.2.272-277.2000. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Centers for Disease Control and Prevention (CDC) Interim guidelines for prevention and control of Staphylococcal infection associated with reduced susceptibility to vancomycin. MMWR Morb Mortal Wkly Rep. 1997 Jul 11;46(27):626-8, 635. [PubMed] [Google Scholar]
  5. Centers for Disease Control and Prevention (CDC) Laboratory capacity to detect antimicrobial resistance, 1998. MMWR Morb Mortal Wkly Rep. 2000 Jan 7;48(51-52):1167–1171. [PubMed] [Google Scholar]
  6. Centers for Disease Control and Prevention (CDC) Staphylococcus aureus with reduced susceptibility to vancomycin--Illinois, 1999. MMWR Morb Mortal Wkly Rep. 2000 Jan 7;48(51-52):1165–1167. [PubMed] [Google Scholar]
  7. Centers for Disease Control and Prevention (CDC) Staphylococcus aureus with reduced susceptibility to vancomycin--United States, 1997. MMWR Morb Mortal Wkly Rep. 1997 Aug 22;46(33):765–766. [PubMed] [Google Scholar]
  8. Climo M. W., Patron R. L., Archer G. L. Combinations of vancomycin and beta-lactams are synergistic against staphylococci with reduced susceptibilities to vancomycin. Antimicrob Agents Chemother. 1999 Jul;43(7):1747–1753. doi: 10.1128/aac.43.7.1747. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cockerill F. R., 3rd, Hughes J. G., Vetter E. A., Mueller R. A., Weaver A. L., Ilstrup D. M., Rosenblatt J. E., Wilson W. R. Analysis of 281,797 consecutive blood cultures performed over an eight-year period: trends in microorganisms isolated and the value of anaerobic culture of blood. Clin Infect Dis. 1997 Mar;24(3):403–418. doi: 10.1093/clinids/24.3.403. [DOI] [PubMed] [Google Scholar]
  10. Cunha B. A. Vancomycin. Med Clin North Am. 1995 Jul;79(4):817–831. doi: 10.1016/s0025-7125(16)30041-4. [DOI] [PubMed] [Google Scholar]
  11. Edmond M. B., Wenzel R. P., Pasculle A. W. Vancomycin-resistant Staphylococcus aureus: perspectives on measures needed for control. Ann Intern Med. 1996 Feb 1;124(3):329–334. doi: 10.7326/0003-4819-124-3-199602010-00008. [DOI] [PubMed] [Google Scholar]
  12. Ena J., Dick R. W., Jones R. N., Wenzel R. P. The epidemiology of intravenous vancomycin usage in a university hospital. A 10-year study. JAMA. 1993 Feb 3;269(5):598–602. [PubMed] [Google Scholar]
  13. Fitch L., Johnson A. P. Reduced susceptibility to teicoplanin in a methicillin-resistant strain of Staphylococcus aureus. J Antimicrob Chemother. 1998 May;41(5):578–578. doi: 10.1093/jac/41.5.578. [DOI] [PubMed] [Google Scholar]
  14. Fridkin S. K., Edwards J. R., Pichette S. C., Pryor E. R., McGowan J. E., Jr, Tenover F. C., Culver D. H., Gaynes R. P. Determinants of vancomycin use in adult intensive care units in 41 United States hospitals. Clin Infect Dis. 1999 May;28(5):1119–1125. doi: 10.1086/514752. [DOI] [PubMed] [Google Scholar]
  15. Geisel R., Schmitz F. J., Thomas L., Berns G., Zetsche O., Ulrich B., Fluit A. C., Labischinsky H., Witte W. Emergence of heterogeneous intermediate vancomycin resistance in Staphylococcus aureus isolates in the Düsseldorf area. J Antimicrob Chemother. 1999 Jun;43(6):846–848. doi: 10.1093/jac/43.6.846. [DOI] [PubMed] [Google Scholar]
  16. Goldstein Fred, Soussy Claude-James, Thabaut André. Definition of the Clinical Antibacterial Spectrum of Activity. Clin Microbiol Infect. 1996 Feb;2 (Suppl 1)(NaN):S40–S45. doi: 10.1111/j.1469-0691.1996.tb00874.x. [DOI] [PubMed] [Google Scholar]
  17. Hanaki H., Kuwahara-Arai K., Boyle-Vavra S., Daum R. S., Labischinski H., Hiramatsu K. Activated cell-wall synthesis is associated with vancomycin resistance in methicillin-resistant Staphylococcus aureus clinical strains Mu3 and Mu50. J Antimicrob Chemother. 1998 Aug;42(2):199–209. doi: 10.1093/jac/42.2.199. [DOI] [PubMed] [Google Scholar]
  18. Hanaki H., Labischinski H., Inaba Y., Kondo N., Murakami H., Hiramatsu K. Increase in glutamine-non-amidated muropeptides in the peptidoglycan of vancomycin-resistant Staphylococcus aureus strain Mu50. J Antimicrob Chemother. 1998 Sep;42(3):315–320. doi: 10.1093/jac/42.3.315. [DOI] [PubMed] [Google Scholar]
  19. Hiramatsu K., Aritaka N., Hanaki H., Kawasaki S., Hosoda Y., Hori S., Fukuchi Y., Kobayashi I. Dissemination in Japanese hospitals of strains of Staphylococcus aureus heterogeneously resistant to vancomycin. Lancet. 1997 Dec 6;350(9092):1670–1673. doi: 10.1016/S0140-6736(97)07324-8. [DOI] [PubMed] [Google Scholar]
  20. Hiramatsu K., Hanaki H., Ino T., Yabuta K., Oguri T., Tenover F. C. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother. 1997 Jul;40(1):135–136. doi: 10.1093/jac/40.1.135. [DOI] [PubMed] [Google Scholar]
  21. Hubert S. K., Mohammed J. M., Fridkin S. K., Gaynes R. P., McGowan J. E., Jr, Tenover F. C. Glycopeptide-intermediate Staphylococcus aureus: evaluation of a novel screening method and results of a survey of selected U.S. hospitals. J Clin Microbiol. 1999 Nov;37(11):3590–3593. doi: 10.1128/jcm.37.11.3590-3593.1999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Johnson A. P. Intermediate vancomycin resistance in Staphylococcus aureus: a major threat or a minor inconvenience? J Antimicrob Chemother. 1998 Sep;42(3):289–291. doi: 10.1093/jac/42.3.289. [DOI] [PubMed] [Google Scholar]
  23. Kantzanou M., Tassios P. T., Tseleni-Kotsovili A., Legakis N. J., Vatopoulos A. C. Reduced susceptibility to vancomycin of nosocomial isolates of methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother. 1999 May;43(5):729–731. doi: 10.1093/jac/43.5.729. [DOI] [PubMed] [Google Scholar]
  24. Kirst H. A., Thompson D. G., Nicas T. I. Historical yearly usage of vancomycin. Antimicrob Agents Chemother. 1998 May;42(5):1303–1304. doi: 10.1128/aac.42.5.1303. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lowy F. D. Staphylococcus aureus infections. N Engl J Med. 1998 Aug 20;339(8):520–532. doi: 10.1056/NEJM199808203390806. [DOI] [PubMed] [Google Scholar]
  26. Maranan M. C., Moreira B., Boyle-Vavra S., Daum R. S. Antimicrobial resistance in staphylococci. Epidemiology, molecular mechanisms, and clinical relevance. Infect Dis Clin North Am. 1997 Dec;11(4):813–849. doi: 10.1016/s0891-5520(05)70392-5. [DOI] [PubMed] [Google Scholar]
  27. Pagano L., Tacconelli E., Tumbarello M., Laurenti L., Mele L., Spanu T., Cauda R., Fadda G., Leone G. Teicoplanin-resistant coagulase-negative staphylococcal bacteraemia in patients with haematological malignancies: a problem of increasing importance. J Antimicrob Chemother. 1997 Nov;40(5):738–740. doi: 10.1093/jac/40.5.738. [DOI] [PubMed] [Google Scholar]
  28. Pfeltz R. F., Singh V. K., Schmidt J. L., Batten M. A., Baranyk C. S., Nadakavukaren M. J., Jayaswal R. K., Wilkinson B. J. Characterization of passage-selected vancomycin-resistant Staphylococcus aureus strains of diverse parental backgrounds. Antimicrob Agents Chemother. 2000 Feb;44(2):294–303. doi: 10.1128/aac.44.2.294-303.2000. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Ploy M. C., Grélaud C., Martin C., de Lumley L., Denis F. First clinical isolate of vancomycin-intermediate Staphylococcus aureus in a French hospital. Lancet. 1998 Apr 18;351(9110):1212–1212. doi: 10.1016/s0140-6736(05)79166-2. [DOI] [PubMed] [Google Scholar]
  30. Rotun S. S., McMath V., Schoonmaker D. J., Maupin P. S., Tenover F. C., Hill B. C., Ackman D. M. Staphylococcus aureus with reduced susceptibility to vancomycin isolated from a patient with fatal bacteremia. Emerg Infect Dis. 1999 Jan-Feb;5(1):147–149. doi: 10.3201/eid0501.990118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Sieradzki K., Roberts R. B., Haber S. W., Tomasz A. The development of vancomycin resistance in a patient with methicillin-resistant Staphylococcus aureus infection. N Engl J Med. 1999 Feb 18;340(7):517–523. doi: 10.1056/NEJM199902183400704. [DOI] [PubMed] [Google Scholar]
  32. Sieradzki K., Roberts R. B., Serur D., Hargrave J., Tomasz A. Heterogeneously vancomycin-resistant Staphylococcus epidermidis strain causing recurrent peritonitis in a dialysis patient during vancomycin therapy. J Clin Microbiol. 1999 Jan;37(1):39–44. doi: 10.1128/jcm.37.1.39-44.1999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Smith T. L., Pearson M. L., Wilcox K. R., Cruz C., Lancaster M. V., Robinson-Dunn B., Tenover F. C., Zervos M. J., Band J. D., White E. Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-Intermediate Staphylococcus aureus Working Group. N Engl J Med. 1999 Feb 18;340(7):493–501. doi: 10.1056/NEJM199902183400701. [DOI] [PubMed] [Google Scholar]
  34. Struelens M. J., Mertens R. National survey of methicillin-resistant Staphylococcus aureus in Belgian hospitals: detection methods, prevalence trends and infection control measures. The Groupement pour le Dépistage, l'Etude et la Prévention des Infections Hospitalières. Eur J Clin Microbiol Infect Dis. 1994 Jan;13(1):56–63. doi: 10.1007/BF02026128. [DOI] [PubMed] [Google Scholar]
  35. Tenover F. C., Lancaster M. V., Hill B. C., Steward C. D., Stocker S. A., Hancock G. A., O'Hara C. M., McAllister S. K., Clark N. C., Hiramatsu K. Characterization of staphylococci with reduced susceptibilities to vancomycin and other glycopeptides. J Clin Microbiol. 1998 Apr;36(4):1020–1027. doi: 10.1128/jcm.36.4.1020-1027.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Vallés J., León C., Alvarez-Lerma F. Nosocomial bacteremia in critically ill patients: a multicenter study evaluating epidemiology and prognosis. Spanish Collaborative Group for Infections in Intensive Care Units of Sociedad Espanola de Medicina Intensiva y Unidades Coronarias (SEMIUC). Clin Infect Dis. 1997 Mar;24(3):387–395. doi: 10.1093/clinids/24.3.387. [DOI] [PubMed] [Google Scholar]
  37. Waldvogel F. A. New resistance in Staphylococcus aureus. N Engl J Med. 1999 Feb 18;340(7):556–557. doi: 10.1056/NEJM199902183400709. [DOI] [PubMed] [Google Scholar]
  38. Weinstein M. P., Towns M. L., Quartey S. M., Mirrett S., Reimer L. G., Parmigiani G., Reller L. B. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis. 1997 Apr;24(4):584–602. doi: 10.1093/clind/24.4.584. [DOI] [PubMed] [Google Scholar]
  39. Zimakoff J., Bangsgaard Pedersen F., Bergen L., Baagø-Nielsen J., Daldorph B., Espersen F., Gahrn Hansen B., Høiby N., Jepsen O. B., Joffe P. Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID). J Hosp Infect. 1996 Aug;33(4):289–300. doi: 10.1016/s0195-6701(96)90015-8. [DOI] [PubMed] [Google Scholar]

Articles from Emerging Infectious Diseases are provided here courtesy of Centers for Disease Control and Prevention

RESOURCES