Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 186, Issue 5, Pages 661-667Publisher
OXFORD UNIV PRESS INC
DOI: 10.1086/342708
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Funding
- NIAID NIH HHS [AI-40481, AI-44999] Funding Source: Medline
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Some Staphylococcus aureus isolates have glycopeptide minimal inhibitory concentrations (MICs) in the susceptible range but have subpopulations that grow on greater than or equal to4 mug/mL vancomycin. Clinical laboratory methods for determining susceptibility have proven to be inadequate for detecting these strains. Among methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) clinical isolates, 149 (66.2%) of 225 and 17 (56.6%) of 30, respectively, grew on brain-heart infusion (BHI) medium containing 2 mug/mL vancomycin; 17 (7.5%) of the MRSA and 2 (6.6%) of the MSSA isolates grew on BHI screening plates containing 4 mug/mL vancomycin. One isolate grew on plates containing 6 mug/mL vancomycin. This isolate escaped detection by routine testing but had a vancomycin MIC of 6 mug/mL when tested in BHI medium. This isolate also had decreased Triton X-100-induced autolysis and killing when incubated in broth media containing vancomycin, properties accorded to glycopeptide-intermediate S. aureus isolates. These observations suggest that glycopeptide-intermediate-like S. aureus isolates are circulating undetected and that a continuum of decreased susceptibility exists in unselected isolates.
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