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Journal of Clinical Microbiology, July 2002, p. 2520-2525, Vol. 40, No. 7
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.7.2520-2525.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Nosocomial Spread of a Staphylococcus capitis Strain with Heteroresistance to Vancomycin in a Neonatal Intensive Care Unit

Wil C. Van Der Zwet,1* Yvette J. Debets-Ossenkopp,1 Erik Reinders,1 Maria Kapi,2 Paul H. M. Savelkoul,1 Ruurd M. Van Elburg,3 Keiichi Hiramatsu,2 and Christina M. J. E. Vandenbroucke-Grauls1

Department of Medical Microbiology and Infection Control,1 Department of Neonatology, VU University Medical Center, Amsterdam, The Netherlands,3 Department of Bacteriology, Juntendo University, Tokyo, Japan2

Received 3 December 2001/ Returned for modification 5 February 2002/ Accepted 3 April 2002

A premature infant in a neonatal intensive care unit (NICU) developed a bloodstream infection caused by coagulase-negative staphylococci (CoNS) sensitive to vancomycin. The infection persisted for 3 weeks, despite therapy with vancomycin and replacement of all intravenous catheters. The neonate died due to necrotizing enterocolitis which developed during the ongoing sepsis. We screened this strain and 216 other strains of CoNS from cultures of blood obtained from neonates between 1997 and 2000 for heteroresistance to vancomycin. Forty-eight isolates, including the strain that caused ongoing sepsis, proved heteroresistant. All isolates were identified as Staphylococcus capitis and were identical, just as their resistant stable subcolonies were, when they were genetically fingerprinted by amplified-fragment length polymorphism analysis. The heteroresistant phenotype of this endemic strain was confirmed by population analysis. We conclude that heteroresistance to vancomycin occurs in S. capitis and might be the cause of therapeutic failures in NICUs. Moreover, heteroresistant strains can become endemic in such units.

* Corresponding author. Mailing address: Department of Medical Microbiology and Infection Control, VU University Medical Center, Postbox 7057, 1007 MB Amsterdam, The Netherlands. Phone: 31-20-4440488. Fax: 31-20-4440473. E-mail: w.zwet{at}vumc.nl.

Journal of Clinical Microbiology, July 2002, p. 2520-2525, Vol. 40, No. 7
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.7.2520-2525.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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