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  • Title: Performance of vancomycin and teicoplanin disk diffusion test in isogenic vancomycin non-susceptible Staphylococcus aureus.
    Author: Wongthong S, Dutchanutouch K, Namsaengkang V, Chanawong A, Wilailuckana C, Lulitanond A.
    Journal: J Infect Dev Ctries; 2015 Feb 19; 9(2):157-64. PubMed ID: 25699490.
    Abstract:
    INTRODUCTION: Detection of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) is currently problematic. Although the population analysis profile with area under the curve (PAP-AUC) is the gold standard for detecting hVISA strains, this method is time consuming. This study aimed to induce vancomycin non-susceptible Staphylococcus aureus isolates in methicillin-resistant S. aureus (MRSA) and to determine the performance of the vancomycin and teicoplanin disk diffusion test for screening of induced and natural vancomycin non-susceptible isolates. METHODOLOGY: Vancomycin resistance was induced in vitro in methicillin-resistant S. aureus by serial passage in media with increasing vancomycin concentrations. All test isolates were confirmed for their susceptibility to vancomycin by using a PAP-AUC method. The performance of the vancomycin and teicoplanin disk diffusion test for detecting both induced and natural hVISA/VISA isolates was analyzed using the MedCal program version 10.2.0. RESULTS: The induction test revealed that 42 of 78 MRSA isolates (53.8%) became hVISA and/or VISA. Using 10, 15, 20, 30 µg vancomycin disks and a 30 µg teicoplanin disk, the highest performance (88.9%) for hVISA/VISA detection (71.1%), sensitivity, 100% specificity, 100% positive predictive value, and 75% negative predictive value) was obtained when a 20 µg vancomycin disk was used at 1.0 McFarland inoculum for a 24-hour incubation. CONCLUSIONS: The results indicated that using a 20 µg vancomycin disk and bacterial inoculum of 1.0 McFarland is simple to perform and provides a primary result for hVISA/VISA screening within 24 hours.
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