Heteroresistant vancomycin intermediate S. aureus (h-VISA) isolated from a patient with orthopedic implant infection treated with glycopeptides: A case report

Abstract

A 37-year old male patient who had and orthopedic implant after a traffic accident,

presented to the Infectious Diseases Clinic. He was accepted as culture

negative surgical site infection. Initial empirical treatment was started with clindamycin

and then it was changed to the glycopeptides. During the follow-up,

implant was removed. Intraoperative culture specimens revealed Methicilline

Resistant Staphylococcus aureus (S. aureus). After antibiotic therapy, total hip

prosthesis was implanted and was removed for two times. Wound discharge was

continued despite restarted the antibiotic treatment and growth of heteroresistant-

Vancomycin intermediate S. aureus was detected in the aspiration culture.

All isolates shared the same clonal properties by pulsed-field gel electrophoresis.

The strain was negative for Panton-Valentine-Leucosidine and were shown

to carry carried a Staphylococcal Cassette Chromosome mec type–III variant

common. After a follow-up lasting eight years, the patient chose to continue his

life without prostheses (Girdlestone method). This case was reported for emphasizing

how difficult to manage medical treatment of prosthesis infections with

developing resistant bacteria and the how important the surgical treatment was.

Keywords

• Orthopedic implant infection,Heteroresistant-Vancomycin intermediate S. aureus,Methicillin-resistant Staphylococcus aureus,Glycopeptide

References

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