Prevalence and in vitro susceptibility pattern of MRSA,VRSA, VISA isolates from various clinical samples in tertiary care hospital

Background: Staphylococcus is notorious for its ability to become resistant to antibiotics. MRSA emerged as nosocomial pathogen in the early 1960. Methicillin Resistant Staphylococcus aureus are implicated in serious infections and nosocomial infection outbreaks, thus limiting the treating options to very few agents such as vancomycin and teicoplanin. Vancomycin has been regarded as the first line drug for the treatment for MRSA but its irrational use lead to emergence of vancomycin resistance. The Aim was to determine the prevalence and resistance of MRSA ,VRSA,VISA isolates from various clinical samples in a tertiary care hospital.Material & Methods:This present prospective study was done in the Microbiology department of Government Medical College. The study was conducted for a period of one and half year i.e from January 2019 to June 2020. All the samples (pus, urine, blood, body fluids, sputum etc) were processed as per standard protocols.Results:Out of 26,471 samples, 6578(24.85%) were found to be culture positive. 1583 isolates were identified as Staphylococcus aureus. Among them 1278(80.7%) were MRSA, 21(1.3%) were VISA and 8(0.5%) were VRSA. Maximum number of MRSA isolates were obtained from orthopaedics ward (22.7%) and Intensive Care Unit and most of them were isolated from pus(45%) followed by blood (19.09%)samples. Among them highest resistance were observed against azithromycin (85.6%), followed by ciprofloxacin (63.5%) and least resistance to rifampicin and doxycycline. Majority of the VISA and VRSA strains were isolated from ICU followed by orthopaedics, surgery. Most of them were isolated from pus followed by blood and urine specimen and most were found to be multidrug resistant while they retained their sensitivity to Linezolid and Teicoplanin.Conclusions:As there is high prevalence of MRSA isolates so the treatment options are limited to vancomycin. Overuse of vancomycin can lead to emergence of VRSA strains. So the need for rational use in the infection-control practices to prevent transmission of MRSA as well as VISA strains. Strict implementation of hand hygiene, decolonization of MRSA carriers,and education of healthcare team will be quite helpful.

Autologous Peripheral Blood Stem Cell Therapy for Chronic Achilles Tendinopathy: Report of Three Cases

@#The treatment of chronic Achilles tendinopathy (CAT) remains challenging. We report three cases of CAT treated with autologous peripheral blood stem cells (PBSCs), following principles developed for chondrogenesis of the knee joint. Outcome measurement with a minimum of one and a half years follow-up showed significant improvement of Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) scores, with reduction of tendon thickness and inflammation on MRI scan.

Bacteriemia por Staphylococcus aureus con sensibilidad disminuida heterogénea a vancomicina: reporte de un caso / Staphylococcus aureus bacteremia with heterogeneous intermediate-level vancomycin resistance: a case report

Staphylococcus aureusmeticilina-resistente (SAMR)es una causa frecuente de bacteriemias intrahospitalarias. Para su tratamiento se utiliza vancomicina y han emergido cepas con sensibilidad disminuida heterogénea (h-VISA) que albergan subpoblaciones con sensibi-lidad reducida a vancomicina. Se comunica un caso de bacteriemia intra-tratamiento con vancomicina por SAMR h-VISA. El aislamiento muestra sensibilidad a vancomicina (CIMvan: 1 µg/mL), sin embargo E-test GRD sugiere h-VISA (CIMvan: 2 µg/mL y CIMtei: 8 µg/mL). El análisis del perfil poblacional - área bajo la curva (PAP-AUC) valida este hallazgo. Se rota a linezolid con resolución clínica.

Methicillin-resistant Staphylococcus aureus (SAMR) is a common cause of nosocomial bacteremia. Vancomycin, a glycopeptide, is widely employed for the therapy of SAMR infections. In recent years, heterogeneous vancomycin-intermediate strains (h-VISA) have emerged. We report a case of intra-treatment bacteremia caused by SAMR h-VISA. The isolate shows susceptibility to vancomycin (MICvan: 1 µg/mL). But the GRD E-test suggests h-VISA (MICvan: 2 µg/mL and MICtei: 8 µg/mL). The population analysis profile - area under the curve (PAP-AUC) validates SAMR h-VISA. Rotation of antibiotic therapy with linezolid is done, with good clinical outcome.

Características moleculares de Staphylococcus aureus susceptível à vancomicina poderia ajudar a prever falhas no tratamento devido a reduzida susceptibilidade à vancomicina / Molecular characteristics of vancomycin-susceptible Staphylococcus aureus could help to predict treatment failure due to reduced vancomycin susceptibility / Características moleculares de Staphylococcus aureus susceptible a la vancomicina podría ayudar a predecir fallas en el tratamiento debido a la reducida susceptibilidad a la vancomicina

Justificativa e Objetivos: Staphylococcus aureus resistente à meticilina (MRSA) é uma das causas mais frequentes de infecções relacionadas à assistência à saúde e comunitárias, e com seu avanço, a vancomicina tornou-se a principal opção terapêutica. Entretanto, o seu uso indiscriminado favoreceu o surgimento de MRSA com reduzida suscetibilidade à vancomicina, comumente associados com falhas no tratamento, bacteremia persistente, hospitalização prolongada e desfechos clínicos adversos. Este estudo avaliou a ocorrência de MRSA com reduzida suscetibilidade à vancomicina e determinou algumas características moleculares em comparação com MRSA suscetível à vancomicina (VS-MRSA). Métodos: Determinação do perfil de suscetibilidade aos antimicrobianos, a concentração inibitória mínima (CIM) e concentração bactericida mínima (CBM) para vancomicina, tolerância à vancomicina, tipagem do SCCmec e agr foram realizadas em um total de 177 MRSA. Posteriormente, foram triados para hVISA por BHIA-3V e BHIA-6V e confirmados com a Análise do Perfil Populacional - Área Abaixo da Curva (PAP-AUC). Resultados: Os fenótipos VT-MRSA e hVISA foram encontrados em 13,6% e 5,1% dos isolados clínicos de MRSA, respectivamente, e a presença de hVISA foi estatisticamente significativa entre os isolados de VT-MRSA (p<0,05). Em VT-MRSA, SCCmec tipo II foi significativamente mais frequente do que em não-VT-MRSA, assim como a presença do agr grupo II. Conclusão: Características moleculares encontradas em MRSA são importantes para a epidemiologia, bem como para demonstrar um padrão em isolados com reduzida suscetibilidade à vancomicina. Testes não-convencionais para detecção destas características podem ser realizados para evitar a identificação errada de VS-MRSA que, consequentemente, resulta em falhas no tratamento com vancomicina.(AU)

Background and Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most frequent causes of healthcare-associated and community-acquired infections and with its advancement, vancomycin became the main therapeutic option. However, its indiscriminate use favored the emergence of MRSA with reduced susceptibility to vancomycin, commonly associated with vancomycin treatment failure, persistent bacteremia, prolonged hospitalization and adverse clinical outcome. This study evaluated the occurrence of MRSA with reduced vancomycin susceptibility and determined some molecular characteristics in comparison with vancomycin-susceptible MRSA (VS-MRSA). Methods: Determination of antimicrobial susceptibility profile, the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) for vancomycin, vancomycin-tolerance, SCCmec and agr typing were performed in a total of 177 MRSA. Thereafter, they were screened for hVISA by BHIA-3V and BHIA-6V and confirmed with population analysis profile - area under the curve method (PAP-AUC). Results: VT-MRSA and hVISA phenotypes were found in 13.6% and 5.1% of clinical isolates of MRSA, respectively, and the presence of hVISA was statistically significant among VT-MRSA isolates (p<0.05). In T-MRSA, SCCmec type II was significantly more frequent than in non-VT-MRSA, as well as the presence of agr group II. Conclusion: Molecular characteristics found in MRSA are important for epidemiology, as well as demonstrate a pattern in reduced vancomycin susceptibility isolates. Non-conventional tests for detection of these characteristics might be performed to prevent misidentification of VS-MRSA that, consequently, results in vancomycin treatment failures.(AU)

Justificación y objetivos: Staphylococcus aureus resistente a la meticilina (MRSA) es una de las causas más frecuentes de infecciones relacionadas con la asistencia sanitaria y comunitarias, y con su avance, a la vancomicina se ha convertido en la principal opción terapéutica. Sin embargo, su uso indiscriminado favoreció el surgimiento de MRSA con reducida susceptibilidad a la vancomicina, comúnmente asociados con fallas en el tratamiento, bacteriemia persistente, hospitalización prolongada y resultados clínicos adversos. Este estudio evaluó la ocurrencia de MRSA con reducida susceptibilidad a la vancomicina y determinó algunas características moleculares en comparación con MRSA susceptible a la vancomicina (VS-MRSA). Métodos: Determinación del perfil de susceptibilidad a los antimicrobianos, la concentración inhibitoria mínima (CIM) y la concentración bactericida mínima (CBM) para vancomicina, tolerancia a la vancomicina, tipificación del SCCmec y agr se realizaron en un total de 177 MRSA. Resultados: Los fenotipos VT-MRSA y hVISA se encontraron en el 13,6% y el 5,1% de los aislados clínicos de MRSA, respectivamente, y la presencia de hVISA fue estadísticamente significativa entre los aislados de VT-MRSA (p<0.05). En VT-MRSA, SCCmec tipo II fue significativamente más frecuente que en no-VT-MRSA, así como la presencia del agr grupo II. Conclusión: Características moleculares encontradas en MRSA son importantes para la epidemiología, así como para demostrar un patrón en aislados con reducida susceptibilidad a la vancomicina. Pruebas no convencionales para la detección de estas características pueden realizarse para evitar la identificación errónea de VS-MRSA que, consecuentemente, resulta en fallas en el tratamiento con vancomicina.(AU)

O visto humanitário como resposta ao pedido de refúgio dos haitianos / The humanitarian visa as a response to Haitians' request for refuge / La visa humanitaria como respuesta al pedido de refugio de los haitianos

Resumo O cenário da migração internacional passou, nas últimas décadas, por profundas mudanças. No caso do Brasil, se a chegada de imigrantes provenientes de países fronteiriços se acentuou, um novo componente desse fluxo inclui, além de importante contingente de brasileiros retornados, imigrantes de regiões com pouco ou nenhum histórico de trocas populacionais com o país. Nesse particular, vale notar a presença de numerosos haitianos. O objetivo deste artigo é discorrer sobre o processo que levou à criação do visto humanitário voltado exclusivamente para os haitianos e sobre sua implantação como política migratória do governo. Para atender a essa proposição, faz-se inicialmente uma breve discussão dessa política, explicitando-se o processo de concessão do visto humanitário aos haitianos e as justificativas para tal. Por fim, buscou-se fazer uma avaliação dessa política de concessão de visto humanitário.(AU)

Abstract La migración internacional pasó, en la última década, por cambios profundos. En Brasil si la llegada de inmigrantes de los países vecinos se ha ampliado, un nuevo componente de este flujo incluí, a parte los repatriados brasileños, inmigrantes de regiones con poca o ninguna historia de intercambios de población con Brasil, en este sentido, es de destacar la presencia de los haitianos. El propósito de este documento es discutir el proceso que condujo a la creación de la figura de la visa humanitaria dedicada exclusivamente a los haitianos y la evaluación de su poceso de implementación como una política migratoria del Gobierno. Para hacer frente a esta proposición, se presenta una breve discusión de la política de inmigración brasileña y, en seguimiento, lo proceso de otorgamiento de visas humanitarias a los haitianos.

Resumen La migración internacional pasó, en la última década, por cambios profundos. En Brasil si la llegada de inmigrantes de los países vecinos se ha ampliado, un nuevo componente de este flujo incluí, a parte los repatriados brasileños, inmigrantes de regiones con poca o ninguna historia de intercambios de población con Brasil, en este sentido, es de destacar la presencia de los haitianos. El propósito de este documento es discutir el proceso que condujo a la creación de la figura de la visa humanitaria dedicada exclusivamente a los haitianos y la evaluación de su poceso de implementación como una política migratoria del Gobierno. Para hacer frente a esta proposición, se presenta una breve discusión de la política de inmigración brasileña y, en seguimiento, lo proceso de otorgamiento de visas humanitarias a los haitianos.

A diáspora Síria: da internacionalização do conflito interno ao tratamento jurídico dispensado pelo estado brasileiro aos migrantes / The Syrian diaspora: from the conflict's internationalization to the internal legal treatment given by the brazilian state to migrants

O conflito sírio gerou, até julho de 2016, 4,8 milhões de deslocados em países vizinhos (Iraque, Egito, Jordânia, Líbano e Turquia) e 900 mil na Europa. Internamente, 6,6 milhões de pessoas encontram-se deslocadas. Conforme o Alto Comissariado das Nações Unidas para Refugiados (ACNUR), 3 em cada 4 sírios vive abaixo da linha da pobreza. A guerra na Síria completou em 2016, 5 anos, e não vê perspectiva de apaziguamento e reestabelecimento da paz. Diante da maior crise de refugiados do nosso tempo, este artigo propõe analisar, de um lado, a internacionalização do conflito sírio e os motivos que levaram a um crescimento no número de refugiados internacionais, bem como os problemas por esses enfrentados em sua região e no continente europeu; e, de outro lado, a posição do Brasil como baluarte de uma política mais aberta ao recebimento de refugiados, visto ser o primeiro país das Américas a adotar procedimento especial que agilizou a concessão de vistos aos sírios. Tal procedimento deu-se através da resolução normativa número 17 do CONARE (Comitê Nacional para Refugiados), de 20/09/2013, o qual confere o visto humanitário a solicitantes oriundos da República Árabe da Síria, com fundamento em razões humanitárias. A resolução vigorou pelo prazo de 2 (dois) anos, sendo renovada, por igual período, em 21/09/2015 (Resolução Normativa CONARE nº 20). Assim, até 21/09/2017, tal resolução permanece em vigor. No desenvolvimento da presente análise, questiona-se a postura do Estado brasileiro e a efetividade de tal procedimento, analisando-se as diferenças entre o status de refugiado respaldado pelo Estatuto dos Refugiados (Lei 9.474/1997) e o visto por razões humanitárias, concedido aos indivíduos afetados pelo conflito da República Árabe da Síria.

The Syrian conflict has generated, until July 2016, 4.8 million displaced people in neighboring countries (Iraq, Egypt, Jordan, Lebanon and Turkey) and 900,000 in Europe. Internally, 6.6 million people are displaced. According to the High Commissioner of the United Nations for Refugees (UNHCR), 3 out of 4 Syrians live below the poverty line. The war in Syria completed in 2016, five years, and don’t see the perspective of reestablishment of peace. Facing the greatest crisis of our time refugees, this article aims to analyze, on the one hand, the internationalization of the Syrian conflict and the reasons that led to an increase in the number of international refugees and the problems those faced in the region and the European continent; and on the other hand, Brazil's position as a bulwark of a more open policy on receiving refugees, as it is the first country in the Americas to adopt special procedures that facilitated the granting of visas to Syrians. This procedure was made through the normative resolution number 17 of CONARE (National Committee for Refugees) of 09.20.2013, which provides humanitarian visa to applicants coming from the Syrian Arab Republic, based on humanitarian grounds. The resolution was launched for a period of two (2) years, and renewed for an equal period, on 21.09.2015 (Normative Resolution CONARE No. 20). So until 09/21/2017 such resolution remains in force. In the development of this analysis, it questions the position of the Brazilian state and the effectiveness of such a procedure, analyzing the differences between the refugee status supported by the Status of Refugees (Law 9.474 / 1997) and the visa on humanitarian grounds, granted individuals affected by the conflict of the Arab Republic of Syria.

Molecular analysis of methicillin-resistant Staphylococcus aureus dissemination among healthcare professionals and/or HIV patients from a tertiary hospital

Abstract INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen in community settings. MRSA colonized individuals may contribute to its dissemination; the risk of MRSA infection is increased in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients, although the prevalence of colonization in this group is not well established. The present study addressed this issue by characterizing MRSA isolates from HIV/AIDS patients and their healthcare providers (HCPs) to determine whether transmission occurred between these two populations. METHODS: A total of 24 MRSA isolates from HIV-infected patients and five from HCPs were collected between August 2011 and May 2013. Susceptibility to currently available antimicrobials was determined. Epidemiological typing was carried out by pulsed-field gel electrophoresis, multilocus sequence typing, and Staphylococcus cassette chromosome (SCCmec) typing. The presence of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) and heterogeneous daptomycin-resistant Staphylococcus aureus (hDRSA) was confirmed by population analysis profile. Isolates characterized in this study were also compared to isolates from 2009 obtained from patients at the same hospital. RESULTS: A variety of lineages were found among patients, including ST5-SCCmecII and ST30-SCCmecIV. Two isolates were Panton-Valentine leukocidin-positive, and hVISA and hDRSA were detected. MRSA isolates from two HCPs were not related to those from HIV/AIDS patients, but clustered with archived MRSA from 2009 with no known relationship to the current study population. CONCLUSIONS: ST105-SCCmecII clones that colonized professionals in 2011 and 2012 were already circulating among patients in 2009, but there is no evidence that these clones spread to or between HIV/AIDS patients up to the 7th day of their hospitalization.

Worrisome trends in rising minimum inhibitory concentration values of antibiotics against methicillin resistant Staphylococcus aureus - Insights from a tertiary care center, South India

ABSTRACT INTRODUCTION: Appearance of isolated reports of resistance to anti-methicillin-resistantStaphylococcus aureus (MRSA) drugs is worrisome underscoring the need to continuously monitor the susceptibility of clinical MRSA isolates to these drugs. Hence, the present study is conducted to determine the susceptibility of MRSA isolates to various classes of anti-MRSA drugs such as vancomycin (glycopeptide), daptomycin (lipopeptide), tigecycline (glycylcycline), and linezolid (oxazolidinone) to determine the MIC50 and MIC90 values, and to observe MIC creep over a three year period, if any, with respect to these drugs. METHODS: A total of 200 isolates of MRSA obtained from clinical specimens were included. MIC was determined by E-test for anti-MRSA antibiotics vancomycin, linezolid, daptomycin, and tigecycline. Non-parametric methods (Kruskal-Wallis and Chi-square test) were used to assess MIC trends over time. In addition, MIC50 and MIC90 values were also calculated. RESULTS: No isolate was found resistant to vancomycin, daptomycin, or linezolid; five isolates were resistant to tigecycline. Seven VISA isolates were encountered with the MIC value for vancomycin of 4 µg/mL. MIC values for vancomycin, tigecycline, linezolid showed a definite increase over a 3-year period which was statistically significant with p-values <0.0001, 0.0032, 0.0242, respectively. When the percentage of isolates with a median MIC value less than or equal to that of the index year was calculated, the change was most striking with vancomycin. The proportion of isolates with higher MIC values was greater in 2014 than 2012 and 2013. CONCLUSION: MIC creep was notably observed with vancomycin, and to some extent with tigecycline and linezolid. Selection pressure may result in creeping MICs, which may herald the emergence of resistant organisms.

Detection of vancomycin susceptibility among clinical isolates of MRSA by using minimum inhibitory concentration method.

Background: Staphylococcus aureus is considered as a major pathogen causing a diversity of infections including bacteremia, pneumonia, skin and soft tissue including osteoarticular infections. Since 1961, Methicillin Resistant Staphylococci aureus (MRSA) emerged has one of the major and common cause of hospital acquired infection. However, due to wide spread usage of vancomycin for MRSA infections resulted in reduced susceptibility of S. aureus to vancomycin has been identified as a serious public health concern. The aim of the study is to identify the Methicillin Resistant Staphylococcus aureus (MRSA) from various clinical samples and to detect vancomycin susceptibility by Minimum Inhibitory Concentration (MIC) method. Methods: This study was conducted over period of one year December 2013 to November 2014. Clinical samples like pus, blood, sputum, urine and cerebrospinal fluid were collected from various clinical departments in Narayana General Hospital for selective isolation of Staphylococcus aureus. A total of 100 Staphylococcal aureus isolates were isolatedby using standard laboratory procedures. MRSA were detected using Oxacillin Disc on Muller Hinton Agar with 4% NaCl. Sensitivity pattern for vancomycin (30 μg) disc and for other recommended antibiotics was determined by Kirby-Bauer’s disk diffusion method. Minimum Inhibitory Concentration (MIC) was done for vancomycin sensitive isolates by standard agar dilution method. Results: Out of 100 S. aureus isolates, all were susceptible to vancomycin (30 μg) by disk diffusion method. But, 82 isolates of MRSA were susceptible to vancomycin at the concentration of 0.5-2 μg/ml of agar. 17 isolates showed intermediate sensitivity to vancomycin, in which 13 isolates with MIC 4μg/ml and 4 isolates with MIC 8 μg/ml and one isolate was resistant to vancomycin even with MIC of 16 μg/ml. Conclusions: The present study reveals the emergence of Vancomycin Intermediate Sensitive Staphylococcus aureus (VISA) and Vancomycin Resistant Staphylococcus aureus (VRSA). Disc diffusion method should not be employed for detection of vancomycin sensitivity for MRSA stains. The major cause may be attributed to unawareness and irrational usage of broad spectrum antibiotics.

Determination of Vancomycin and Methicillin Resistance in Clinical Isolates of Staphylococcus aureus in Iranian Hospitals.

Aims: The aim of this study was to determine the prevalence of methicillin resistant S. aureus (MRSA), vancomycin resistant or vancomycin intermediate resistant S. aurues (aureus) (VRSA/VISA) among clinical isolates. Study Design: S.aureus isolates used in this study were randomly collected from in-patient and outpatient of several hospitals of 7 cities in Iran (Tehran, Shiraz, Zahedan, Tabriz, Sannandaj, Sari, and Ahvaz) during 2006-2008. Methodology: Antibiotic susceptibility of 250 strains of Staphylococcus aureus isolated from Iranian hospitals were determined by disk diffusion method. Minimum inhibitory concentration (MICs) were determined for oxacillin and vancomycin by E-test. PCRs were used by specific primers (PCR used specific primers) for detection of mecA, vanA, vanB genes. Results: The percentage of resistance by disk diffusion method was as below: methicillin 46%, vancomycin 0%, penicillin 86%, erythromycin 42%, ciprofloxacin 29%, gentamicin 39% and clindamycin 33%. E-test MIC method showed that 43% isolates were resistant to methicillin and 4% isolates were VISA (≤ 8μg/ml). The prevalence of resistance genes in the clinical isolates were: mecA 44%, vanA 0%, vanB 0%. Conclusion: This study revealed that clinical isolates have rather high resistance to methicillin, erythromycin, gentamicin, penicillin and clindamycin We did not observe resistance to vancomycin. In order to avoid a possible outbreak involving VISA), vancomycin should be used carefully as a drug for treatment of S. aureus infections.

Vancomycin Resistance of Staphylococcus aureus in Korean Primary Hospitals

According to a United States study, 13 cases of vancomycin-resistant Staphylococcus aureus (VRSA) have been reported to date. In 2001, a survey conducted in Korea revealed that 0.5% of methicillin-resistant S. aureus (MRSA) isolates have a vancomycin minimum inhibitory concentration (MIC) of 4 microg/ml, and are thus referred to as vancomycin intermediate S. aureus (VISA). However there are no reports of VISA found in primary hospitals. We evaluated the MIC of vancomycin in MRSA samples obtained from primary hospitals to determine whether VISA was present in primary hospitals. The population analysis was performed to determine whether hetero-VISA was present in primary hospitals. As a result, twenty of the 103 isolates were S. aureus which were all MRSA and the vancomycin MIC was similar to that seen in tertiary hospitals. Population analysis confirmed that three strains were hetero-VISA, by showing that one strain grew in 8 microg/ml vancomycin and that two strains grew in 4 microg/ml vancomycin. In conclusion, hetero-VISA was detected in Korean primary hospitals, which may develop into VISA, however a larger sample size will be needed to confirm these results.

Two Cases of Vancomycin-intermediate Staphylococcus aureus Isolated from Joint Tissue or Wound / 대한진단검사의학회지

Since its first isolation in 1997, vancomycin-intermediate Staphylococcus aureus (VISA) has been a clinical concern because it may lead to treatment failure. Up to the present, there were two reports of clinical VISA cases in Korea. We now report two additional cases of VISA with the minimum inhibitory concentration (MIC) of 4 microgram/mL. The first patient was a 59 yr-old man who had undergone total hip replacement arthroplasty in 1999 due to avascular necrosis of femur heads. He had recurrent episodes of infected hip caused by methicillin-resistant Staphylococcus aureus (MRSA) and was treated with vancomycin. He underwent replacement operation of prosthesis. Cultures of joint fluid and joint tissue grew S. aureus. Vancomycin MIC as determined by a broth microdilution method was 4 microgram/mL for the both isolates. The patient was treated with high enough doses of vancomycin to maintain serum trough concentrations at 20-25 microgram/mL for 52 days and was discharged. The second patient was a 57 yr-old man with diabetes. He lost consciousness from drinking. After recovery of consciousness, he was diagnosed with aspiration pneumonia. MRSA and Acinetobacter baumannii were cultured from sputum and the patient was treated with vancomycin and meropenem. During hospitalization, bed sores developed in his ankle and back. A wound culture from the sore grew S. aureus with vancomycin MIC of 4 microgram/mL. Since infection was localized, systemic antibiotics did not seem necessary, and the patient was transferred to another hospital for isolation and management.

Staphylococcus aureus: visitando uma cepa de importância hospitalar / Staphylococcus aureus: visiting a strain of clinical importance

O Staphylococcus aureus é uma bactéria do grupo dos cocos gram-positivos que faz parte da microbiota humana, mas que pode provocar doenças que vão desde uma infecção simples, como espinhas e furúnculos, até as mais graves, como pneumonia, meningite, endocardite, síndrome do choque tóxico e septicemia, entre outras. Essa bactéria foi uma das primeiras a serem controladas com a descoberta dos antibióticos, mas, devido a sua enorme capacidade de adaptação e resistência, tornou-se uma das espécies de maior importância no quadro das infecções hospitalares e comunitárias. Neste artigo faremos uma revisão sobre esse agente infeccioso e as bases dos mecanismos das patologias por ele provocadas, de forma a ressaltar a necessidade de mantê-lo como alvo para o desenho de novos antibióticos.

Staphylococcus aureus is a bacterium from Gram-positive coccus group, which is part of the human microbiota. It may cause diseases that may vary from simple infections (i.e., pimples and furuncles) to severe infections, such as pneumonia, meningitis, endocarditis, toxic shock syndrome and septicemia, among others. This bacterium was one of the first bacteria affected by antibacterial agents, however, its ability of adaptation and resistance turns it into an important hospital and communitarian pathogenic species of great concern. In this article we will discuss some important points related to the S. aureus and the pathologies related to it to reinforce it as a target for the design of new antibiotics.

Synergy of Arbekacin-based Combinations Against Vancomycin Hetero-intermediate Staphylococcus aureus

This study was undertaken to evaluate the in vitro activities of arbekacin-based combination regimens against vancomycin hetero-intermediate Staphylococcus aureus (hetero-VISA). Combinations of arbekacin with vancomycin, rifampin, ampicillin-sulbactam, teicoplanin, or quinipristin-dalfopristin against seven hetero-VISA strains and two methicillin-resistant S. aureus strains were evaluated by the time-kill assay. The combinations of arbekacin with vancomycin, teicoplanin, or ampicillinsulbactam showed the synergistic interaction against hetero-VISA strains. Data suggest that these arbekacin-based combination regimens may be useful candidates for treatment options of hetero-VISA infections.

Statistical Analysis of Serologic Test for Syphilis in Normal Population (1981 ~ 1984) / 대한피부과학회지

Serologic tests for syphilis including VDRL and TPHA tests were carried out in 5,413 VISA applicants for emigration, from January, 1981 to December, l984 The results are summarized as follows: 1. In 5,413 VISA applicants, the reactive rate of VDRL test was 2,0% totally. The reactive rate of VDRL test of male was 2. 6%, and that of female was 1. 6% 2. The reactive rate of 1983 was 1.4% and that was the lowest in annual incidence, but there was no statistically significant differences in comparing the annual incidences. 3. The reactive rate increased with age, and males above the 5 th decade revealed an especially high reactive rate. 4. The biologic false positive rate of VDRL teet was 16. 5%, in gl VDRL reactive persons, using TPHA as standard. 5. The quantitative test of VDRL showed low titer below 1: 4 in 88. 4%, and high titer above 1: 8 in 11. 6% of the applicants.