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

Year 2017, Volume: 34 Issue: 2, 149 - 154, 08.09.2017

Vildan Avkan Oguz , Hatice Kose Nur Yapar Vasfi Karatosun Zeynep Gulay

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

• Castillo-Ramirez, S., Coranker, J., Marttinen, P., Aldeljawi, M., Hanage, W.P., Westh, H., Boye, K., Gulay, Z., Bentley, S.D., Parkhill, J., Holden, M.T., Feil, E.J., 2012. Phylogeographic variation ın recombination rates within a global clone of methicillin resistant Staphylococcus aureus. Genome Biol. 13. R126. doi:10.1186/gb-2012-13-12-r126. CDC reminds clinical laboratories and healthcare infection preventionists of their role in the search and containment of vancomycinresistant Staphylococcus aureus (VRSA). http://www.cdc.gov/HAI/settings/lab/vrsa_lab_search_containment.html (Accessed August 13, 2014) Cesur, S., Irmak, H., Şimşek, H., Cöplü, N., Kılıç, H., Arslan, U., Bayramoğlu, G., Baysan, B.O., Gülay, Z., Hoşoğlu, S., Berktaş, M., Gencer, S., Demiröz, A.P., Esen, B., Karabiber, N., Aydın, F., Yalçın, A.N., 2012. Evaluation of antibiotic susceptibilities and VISA-VRSA rates among MRSA strains isolated from hospitalized patients in intensive care units of hospitals in seven provinces of Turkey. Mikrobiyol Bul. 46, 352-358 Dubee, V., Zeller, V., Lhotellier, L. Kitzis, M.D., Ziza, J.M., Mamoudy, P., Desplaces, N., 2013. Continuous high-dose vancomycin combination therapy for methicillin resistant staphylococcal prosthetic hip infection: a prospective cohort study. Clin. Microbial Infect. 19, E98-E105. doi:10.1111/1469-0691.12071. Gill, S.R. 2009. Staphylococci in human disease. 2nd Ed., Wiley-Blackwell. pp. 19-30. Gülmez, D., Sancak, B., Ercis, S., Karakaya, J., Hasçelik, G., 2012. Investigation of SCCmec types and panton-valentine leukocidin in community-acquired and nosocomial Staphylococcus aureus strains: comparing skin and soft tissue infections to the other infections. Mikrobiyol Bul. 46, 341-351. Karahan, Z.C., Tekeli, A., Adaleti, R., Koyuncu, E., Dolapci, I., Akan, O.A., 2008. Investigation of panton-valentine leukocidin genes and SCCmec Types in clinical Staphylococcus aureus isolates from Turkey. Microb. Drug. Resist. 14, 203-210. doi: 10.1089/mdr.2008.0811. Liu, C., Chen, Z.J., Sun, Z., Feng, X., Zou, M., Cao, W., Wang, S., Zeng, J., Wang, Y., Sun, M., 2014. Molecular characteristics and virulence factors in methicillin-susceptible, resistant, and heterogeneous vancomycin-intermediate Staphylococcus aureus from central-southern China. J. Microbiol. Immunol. Infect. 48, 490-496 doi: 10.1016/j.jmii. Melo Cristino, J., 2013. The first case of infection with vancomycin resistant staphylococcus aureus in Europe. Lancet. 20, 382, 205. doi: 10.1016/S0140-6736(13)61219-2. Moravvei, Z., Estaji, F., Askari, E., Solhjou, K., Naderi Nasab, M., Saadat, S., 2013. Update on the global number of vancomycinresistant Staphylococcus aureus (VRSA) strains. Int. J. Antimicrob. Agents. 42, 370-371. doi: 10.1016/j.ijantimicag.2013.06.004 Rossi, F., Diaz, L., Wollam, A., Panesso, D., Zhou, Y., Rincon, S., Narechania, A., Xing, G., Di Gioia, TS., Doi, A., Tran, T.T., Reyes, J., Munita, J.M., Carvajal, L.P., Hernandez-Roldan, A., Brandão, D., van der Heijden, I.M., Murray, B.E., Planet, P.J., Weinstock, G.M., Arias, C.A., 2014. Transferable vancomycin resistance in a community-associated MRSA lineage. N. Eng. J. Med. 370, 1524-1531. doi: 10.1056/NEJMoa1303359. Rybak, M.J., Leonard, S.N., Rossi, K.L., Cheung, C.M., Sader, H.S., Jones, R.N., 2008. Characterization of vancomycin heteroresistant Staphylococcus aureus from the metropolitan area of detroit, Michigan, over a 22-Year Period (1986 to 2007). J. Clin. Microbiol. 46, 2950-2954. doi: 10.1128/JCM.00582-08. Saleh-Mghir, A., Ameur, N., Muller Serieys, C., Ismael, F., Lemaitre, F., Massias, L., Feger, C., Bléton, R., Crémieux, A.C., 2002. Combination of quinupristin-dalfopristin (Synercid) and rifampin Is highly synergistic in experimental Staphylococcus aureus joint prosthesis infection. Antimicrob. Agent. Chemother. 46, 1122-1124. doi: 10.1128/AAC.46.4.1122-1124.2002. Sancak, B., Ercis, S., Menemenlioğlu, D. Colakoglu, S., Hasçelik, G., 2005. Methicillin-resistant Staphylococcus aureus heterogeneously resistant to vancomycin in a Turkish university hospital. J. Antimicrob. Chemother. 56, doi: 519–523. https:// doi.org/10.1093/jac/dki272 Sancak, B., Yagcı, S., Gür, D., Gülay, Z., Ogunc, D., Söyletir, G., Yalcin, A.N., Dündar, D.O., Topçu, A.W., Aksit, F., Usluer, G., Ozakin, C., Akalin, H., Hayran, M., Korten, V., 2013. Vancomycin and daptomycin minimum inhibitory concentration distrubition and occurrence of heteroresistance among methicillin-resistant Staphylococcus aureus blood isolated in Turkey. BMC. Infect. Dis. 13: 583. doi:10.1186/1471-2334-13-583. Sola, C., Lamberghini, R.O., Ciarlantini, M., Egea, A.L., Gonzalez, P., Diaz, E.G., Huerta, V., Gonzalez, J., Corso, A., Vilaro, M., Petiti, J.P., Torres, A., Vindel, A., Bocco, J.L., 2011. Heterogeneous vancomycin-intermediate susceptibility in acommunityassociated methicillin-resistant Staphylococcus aureus epidemic clone, in a case of Infective Endocarditis in Argentina. Ann. Clin. Microbiol. Antimicrob. Apr. 28;10:15. doi: 10.1186/1476-0711-10-15. Szabo, J., 2009. h VISA/VISA diagnostic ve therapeutic problems. Expert Rev Anti Infect. Ther. 7, 1-3. doi: 10.1586/14787210.7.1.1. Van Hal, S.J., Paterson, D.L., 2011. Systematic review and meta-analysis of the significance of heterogeneous vancomycinintermediate Staphylococcus aureus isolates. Antimicrob. Agents. Chemother. 55, 405-410. doi: 10.1128/AAC.01133-10. Wootton, M., Howe, R.A., Hillman, R., Walsh, T.R., Bennett, P.M., MacGowan, A.P., 2001. A modified population analysis profile (PAP) method to detect hetero-resistance to vancomycin in Staphylococcus aureus in a UK hospital. J. Antimicrob. Chemother. 47, 399-403. Wootton, M., MacGowan, AP., Walsh, T.R., Howe, R.A., 2007. A multicenter study evaluating the current strategies for isolating Staphylococcus aureus strains with reduced susceptibility to glycopeptides. J. Clin. Microbiol. 45, 329-332. doi:10.1128/ JCM.01508-06