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Detection of heterogeneous vancomycin intermediate resistance in MRSA isolates from Latin America

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dc.contributor.author Castro, Betsy E.
dc.contributor.author Berrio, Maritza
dc.contributor.author Vargas, Monica L.
dc.contributor.author Carvajal, Lina P.
dc.contributor.author Millan, Lina V.
dc.contributor.author Rios, Rafael
dc.contributor.author Hernandez, Angie K.
dc.contributor.author Rincon, Sandra
dc.contributor.author Cubides, Paola
dc.contributor.author Forero, Erika
dc.contributor.author Dinh, An
dc.contributor.author Seas, Carlos
dc.contributor.author Munita, Jose M.
dc.contributor.author Arias, Cesar A.
dc.contributor.author Reyes, Jinnethe
dc.contributor.author Diaz, Lorena
dc.date.accessioned 2020-07-14T00:01:03Z
dc.date.available 2020-07-14T00:01:03Z
dc.date.issued 2020
dc.identifier.uri https://hdl.handle.net/20.500.12866/8258
dc.description.abstract BACKGROUND: Vancomycin is a common first-line option for MRSA infections. The heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) phenotype is associated with therapeutic failure. However, hVISA isolates are usually reported as vancomycin susceptible by routine susceptibility testing procedures. OBJECTIVES: To detect and characterize the hVISA phenotype in MRSA isolates causing infections in nine Latin American countries. METHODS: We evaluated a total of 1189 vancomycin-susceptible MRSA isolates recovered during 2006-08 and 2011-14. After an initial screening of hVISA using glycopeptide-supplemented agar strategies, the detection of hVISA was performed by Etest (GRD) and Macro-method (MET). Isolates deemed to be hVISA were subjected to population analysis profile/AUC (PAP/AUC) and WGS for further characterization. Finally, we interrogated alterations in predicted proteins associated with the development of the VISA phenotype in both hVISA and vancomycin-susceptible S. aureus (VSSA) genomes. RESULTS: A total of 39 MRSA isolates (3.3%) were classified as hVISA (1.4% and 5.6% in MRSA recovered from 2006–08 and 2011–14, respectively). Most of the hVISA strains (95%) belonged to clonal complex (CC) 5. Only 6/39 hVISA isolates were categorized as hVISA by PAP/AUC, with 6 other isolates close (0.87–0.89) to the cut-off (0.9). The majority of the 39 hVISA isolates exhibited the Leu-14→Ile (90%) and VraT Glu-156→Gly (90%) amino acid substitutions in WalK. Additionally, we identified 10 substitutions present only in hVISA isolates, involving WalK, VraS, RpoB and RpoC proteins. CONCLUSIONS: The hVISA phenotype exhibits low frequency in Latin America. Amino acid substitutions in proteins involved in cell envelope homeostasis and RNA synthesis were commonly identified. Our results suggest that Etest-based methods are an important alternative for the detection of hVISA clinical isolates. en_US
dc.language.iso eng
dc.publisher Oxford University Press
dc.relation.ispartof urn:issn:1460-2091
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject phenotype en_US
dc.subject vancomycin en_US
dc.subject gait en_US
dc.subject heterogeneity en_US
dc.subject agar en_US
dc.subject genome en_US
dc.subject latin america en_US
dc.subject methicillin-resistant staphylococcusaureus en_US
dc.subject whole genome sequencing en_US
dc.title Detection of heterogeneous vancomycin intermediate resistance in MRSA isolates from Latin America en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1093/jac/dkaa221
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.01.05
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#1.06.01


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