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Journal of Clinical Microbiology, November 1999, p. 3590-3593, Vol. 37, No. 11
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Glycopeptide-Intermediate Staphylococcus aureus: Evaluation of a Novel Screening Method and Results of a Survey of Selected U.S. Hospitals

Susannah K. Hubert,1 Jasmine M. Mohammed,2 Scott K. Fridkin,2 Robert P. Gaynes,2 John E. McGowan Jr.,1,* and Fred C. Tenover2

Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia 30322,1 and Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia 303332

Received 15 March 1999/Returned for modification 10 May 1999/Accepted 17 August 1999

Isolates of Staphylococcus aureus with decreased susceptibilities to glycopeptide antimicrobial agents, such as vancomycin and teicoplanin, have emerged in the United States and elsewhere. Commercially prepared brain heart infusion agar (BHIA) supplemented with 6 µg of vancomycin per ml was shown in a previous study to detect glycopeptide-intermediate S. aureus (GISA) with high sensitivity and specificity; however, this medium, when prepared in-house, occasionally showed growth of vancomycin-susceptible control organisms. This limitation could significantly impact laboratories that prepare media in-house, particularly if they wished to conduct large surveillance studies for GISA. Therefore, a pilot study to detect GISA was performed with vancomycin-containing Mueller-Hinton agar (MHA) prepared in-house in place of commercially prepared BHIA. MHA was selected for this study because this medium is widely available and well standardized. The results of the pilot study showed that supplementation of MHA with 5 µg of vancomycin per ml was both a sensitive and a specific method for screening for GISA isolates. This method was used to screen for GISA among 630 clinical isolates of methicillin-resistant S. aureus collected during 1997 from 33 U.S. hospitals. Although 14 S. aureus isolates grew on the screening agar, all were vancomycin susceptible (MICs were <= 1 µg/ml) by broth microdilution testing. Population analyses of five isolates revealed two with a subpopulation for which vancomycin MICs were 8 µg/ml. In summary, the MHA screen plate containing 5 µg of vancomycin per ml prepared in-house provides a sensitive and cost-effective method for large-scale screening for GISA for which vancomycin MICs are 8 µg/ml. However, confirmation of isolates as vancomycin resistant is critical. This study suggests that GISA was not a widespread problem in the United States in 1997.

* Corresponding author. Mailing address: Dept. of Epidemiology, Emory University, 1518 Clifton Rd. NE (Room 442GCR), Atlanta, GA 30322. Phone: (404) 727-9365. Fax: (404) 727-8737. E-mail: jmcgowa{at}sph.emory.edu.

Journal of Clinical Microbiology, November 1999, p. 3590-3593, Vol. 37, No. 11
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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