Detection of Heterogeneous Vancomycin Intermediate Resistance in Methicillin- Resistant Staphylococcus Aureus Clinical Isolates
Abstract
Objective: To detect methicillin-resistant Staphylococcus aureus (MRSA) using the cefoxitin disk diffusion method. The study also determined the minimum inhibitory concentration (MIC) of vancomycin through the broth microdilution (BMD) method and categorized it into vancomycin sensitive-MRSA (VS-MRSA), vancomycin intermediate-MRSA (VI-MRSA), and vancomycin resistance-MRSA (VR-MRSA). All the VS-MRSA strains were screened for heterogeneous vancomycin intermediate-MRSA (hV-MRSA).
Material and Methods: In this cross-sectional study, 210 MRSA strains were isolated from the different types of clinical specimens. Vancomycin susceptibility in MRSA isolates was investigated by determining the MIC using the BMD method. We used brain heart infusion screen agar with 4 µg/ml of vancomycin (BHIV4) to screen VS-MRSA strains for hV-MRSA and performed the modified population analysis profile area under the curve (PAP-AUC) method to confirm hV-MRSA.
Results: On the basis of MIC determination of vancomycin, out of the 210 MRSA strains, we found 202 VS-MRSA, 7 VI-MRSA, and 1 VR-MRSA. BHIV4 applied and screened 202 VS-MRSA isolates, and these were confirmed with the PAP-AUC method, which revealed 34 hV-MRSA.
Conclusion: All MRSA strains identified from the different clinical samples had a prevalence of hV-MRSA, 16.83%. Most of the hV-MRSA detected from the VS-MRSA strains showing the MIC of vancomycin on the borderline (2 µg/ml) indicate that the hV-MRSA is a prior stage of development of VI-MRSA.
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