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Infection Control Implications of Protracted Lengths of Stay With Noninfluenza Viral Influenza-Like Illnesses in Hospitalized Adults During the 2015 Influenza A (H3N2) Epidemic [Letter]

Cunha, Burke A; Connolly, James J; Musta, Adina C; Abruzzo, Eileen
PMID: 26324858
ISSN: 1559-6834
CID: 3433722

Disseminated Coccidiomycosis In A Non-Endemic Area Diagnosed Using Endobronchial Ultrasound [Meeting Abstract]

Habtes, I.; Prakash, B.; Gupta, M.; Musta, A.; Newitz, D.; Mathew, J.
ISI:000209838200741
ISSN: 1073-449x
CID: 3426252

Relevance of vancomycin-intermediate susceptibility and heteroresistance in methicillin-resistant Staphylococcus aureus bacteraemia

Khatib, Riad; Jose, Jinson; Musta, Adina; Sharma, Mamta; Fakih, Mohamad G; Johnson, Leonard B; Riederer, Kathleen; Shemes, Stephen
OBJECTIVES/OBJECTIVE:To assess the relevance of vancomycin-intermediate susceptibility (VISA) and heteroresistance (hVISA) in methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. METHODS:We determined vancomycin MICs for 371 saved MRSA blood isolates (2002-03; 2005-06) by Etest and broth microdilution (BMD), screened for hVISA (Etest methods), determined the population analysis profile (PAP)/AUC for isolates with suspected reduced susceptibility (MICs >2 mg/L and/or hVISA-screen-positive versus Mu3 (hVISA control), and stratified patient characteristics and outcome according to susceptibility phenotype: VISA (PAP/AUC >1.3), hVISA (PAP/AUC 0.9-1.3), and susceptible (S-MRSA; PAP/AUC <0.9). RESULTS:PAP/AUC revealed 6 (1.6%) VISA and 30 (8.1%) hVISA phenotypes. The Etest MIC was above the susceptibility cut-off (2 mg/L) for all VISA isolates, whereas the BMD MIC was within the susceptibility range in two (33.3%) instances. Eight hVISA isolates (26.7%) with MICs of 2 mg/L were hVISA-screen negative. SCCmec typing revealed SCCmec II in 100% of VISA, 86.7% of hVISA and 75.5% of S-MRSA isolates (P = 0.04). Prior vancomycin use was documented in 100% of VISA, 73.3% of hVISA and 52.2% of S-MRSA cases (P = 0.002). Outcome (compared in 243 vancomycin-treated patients with MICs of 2 mg/L) revealed longer time to clearance in VISA cases [12.1 ± 13.1 days versus 3.3 ± 3.9 (hVISA) and 3.7 ± 5.1 (S-MRSA); P = 0.001], more frequent endocarditis [33.3% versus 9.1% (hVISA; P = 0.1) and 4.2% (S-MRSA; P = 0.001)] and attributable mortality [33.3% versus 9.1% (hVISA; P = 0.1) and 8.4% (S-MRSA); P = 0.08]. CONCLUSIONS:No adverse outcome was documented with hVISA phenotype, whereas VISA contributed to vancomycin treatment failure. VISA and hVISA appear to emerge in SCCmec II isolates among vancomycin-exposed patients and are better detected by Etest.
PMID: 21525024
ISSN: 1460-2091
CID: 3535042

Vancomycin MIC plus heteroresistance and outcome of methicillin-resistant Staphylococcus aureus bacteremia: trends over 11 years

Musta, Adina C; Riederer, Kathleen; Shemes, Stephen; Chase, Patrick; Jose, Jinson; Johnson, Leonard B; Khatib, Riad
Vancomycin MICs (V-MIC) and the frequency of heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) isolates are increasing among methicillin (meticillin)-resistant Staphylococcus aureus (MRSA) isolates, but their relevance remains uncertain. We compared the V-MIC (Etest) and the frequency of hVISA (Etest macromethod) for all MRSA blood isolates saved over an 11-year span and correlated the results with the clinical outcome. We tested 489 isolates: 61, 55, 187, and 186 isolates recovered in 1996-1997, 2000, 2002-2003, and 2005-2006, respectively. The V-MICs were < or = 1, 1.5, 2, and 3 microg/ml for 74 (15.1%), 355 (72.6%), 50 (10.2%), and 10 (2.1%) isolates, respectively. We detected hVISA in 0/74, 48/355 (13.5%), 15/50 (30.0%), and 8/10 (80.0%) isolates with V-MICs of < or = 1, 1.5, 2, and 3 microg/ml, respectively (P < 0.001). The V-MIC distribution and the hVISA frequency were stable over the 11-year period. Most patients (89.0%) received vancomycin. The mortality rate (evaluated with 285 patients for whose isolates the trough V-MIC was > or = 10 microg/ml) was comparable for patients whose isolates had V-MICs of < or = 1 and 1.5 microg/ml (19.4% and 27.0%, respectively; P = 0.2) but higher for patients whose isolates had V-MICs of > or = 2 microg/ml (47.6%; P = 0.03). However, the impact of V-MIC and hVISA status on mortality or persistent (> or = 7 days) bacteremia was not substantiated by multivariate analysis. Staphylococcal chromosome cassette mec (SCCmec) typing of 261 isolates (including all hVISA isolates) revealed that 93.0% of the hVISA isolates were SCCmec type II. These findings demonstrate that the V-MIC distribution and hVISA frequencies were stable over an 11-year span. A V-MIC of > or = 2 microg/ml was associated with a higher rate of mortality by univariate analysis, but the relevance of the V-MIC and the presence of hVISA remain uncertain. A multicenter prospective randomized study by the use of standardized methods is needed to evaluate the relevance of hVISA and determine the optimal treatment of patients whose isolates have V-MICs of > or = 2.0 microg/ml.
PMCID:2691078
PMID: 19369444
ISSN: 1098-660x
CID: 3535032