Whitener Cynthia J, Park Sarah Y, Browne Fred A, Parent Leslie J, Julian Kathleen, Bozdogan Bulent, Appelbaum Peter C, Chaitram Jasmine, Weigel Linda M, Jernigan John, McDougal Linda K, Tenover Fred C, Fridkin Scott K
The Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA.
Clin Infect Dis. 2004 Apr 15;38(8):1049-55. doi: 10.1086/382357. Epub 2004 Mar 24.
We report findings from our investigation of the world's second clinical isolate of vancomycin-resistant Staphylococcus aureus (VRSA). An elderly man was hospitalized with an infected chronic heel ulcer and osteomyelitis. Before hospital admission, he received multiple courses of antibiotic therapy but, notably, no vancomycin. Numerous cultures of ulcer specimens (performed on an outpatient basis) grew methicillin-resistant, vancomycin-susceptible S. aureus and vancomycin-resistant Enterococcus species. At admission, an additional culture of a specimen from the heel ulcer grew S. aureus that was identified as VRSA (minimal inhibitory concentration for vancomycin [by broth-microdilution], 32 microg/mL). Further evaluation confirmed the presence of the vanA gene mediating vancomycin resistance. To assess VRSA transmission, we performed a carriage study of 283 identified contacts and an environmental survey of the patient's home; no VRSA isolates were recovered. This case illustrates that recent exposure by patients to vancomycin is not necessary for development of vanA-containing VRSA. For clinical and public health reasons, it is essential that microbiology laboratories adequately test for vancomycin-resistance in S. aureus.
我们报告了对世界上第二株耐万古霉素金黄色葡萄球菌（VRSA）临床分离株的调查结果。一名老年男性因慢性足跟溃疡感染和骨髓炎住院。入院前，他接受了多疗程抗生素治疗，但值得注意的是，未使用万古霉素。溃疡标本的多次培养（在门诊进行）培养出耐甲氧西林、对万古霉素敏感的金黄色葡萄球菌和耐万古霉素肠球菌。入院时，足跟溃疡标本的另一次培养培养出金黄色葡萄球菌，被鉴定为VRSA（万古霉素的最低抑菌浓度[通过肉汤微量稀释法]为32μg/mL）。进一步评估证实存在介导万古霉素耐药性的vanA基因。为评估VRSA传播情况，我们对283名已识别的接触者进行了携带情况研究，并对患者家中进行了环境调查；未分离出VRSA菌株。该病例表明，患者近期接触万古霉素并非含vanA的VRSA产生的必要条件。出于临床和公共卫生原因，微生物实验室对金黄色葡萄球菌进行万古霉素耐药性的充分检测至关重要。
