Sains Malaysiana 51(3)(2022): 795-801

http://doi.org/10.17576/jsm-2022-5103-13

Heterogeneous Vancomycin-Intermediate Staphylococcus aureus (HVISA) at a Tertiary Hospital in Malaysia

(Heterogen Pertengahan Vankomisin Staphylococcus aureus (HVISA) di Sebuah Hospital Tertier di Malaysia)

BAKHTIYAR MAHMOOD HAMASALIH¹, HUI-MIN NEOH², ROSNI IBRAHIM³, LAILATUL AKMAR MAT NOR⁴ & TENGKU ZETTY MAZTURA TENGKU JAMALUDDIN^5,*

¹Department of Biology, College of Education, University of Garmian, Iraq  

²UKM Medical Molecular Biology Institute (UMBI), Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia  

³Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor Darul Ehsan, Malaysia  

⁴Microbiology Unit, Department of Pathology, Hospital Serdang, Jalan Puchong, 43000 Kajang, Selangor Darul Ehsan, Malaysia  

⁵Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia

Received: 1 February 2021/Accepted: 26 July 2021

ABSTRACT

Methicillin-resistant Staphylococcus aureus remains a global problem. The emergence of reduced susceptibility to Vancomycin in MRSA strains, leads to treatment failure and prolonged hospital stay. Therefore, we aimed to determine the strains with reduced susceptibility among MRSA clinical isolates. S. aureus isolates were collected from identified clinical samples. Antibiotic susceptibility was tested using the Kirby-Bauer method. MRSA strains were confirmed using PCR for mecA gene and subjected to the Epsilometer test (Etest®) for determination of Vancomycin minimum inhibitory concentration (MIC). Isolates with intermediate or reduced susceptibility were subjected to broth microdilution (BMD) and further confirmed by population analysis-area under curve (PAP-AUC) testing. Disc diffusion tests showed that all isolates (n = 105; 100%) were susceptible to Rifampicin, followed by Trimethoprim/Sulfamethoxazole. Meanwhile, a high resistance rate was demonstrated against Penicillin (n = 93; 88.6%). Among all isolates, only 26.0% (n = 27) were MRSA. According to the Vancomycin MIC value by Etest®, only two strains (A3, A106) had intermediate susceptibility, and one strain (A30) had reduced susceptibility to Vancomycin (MIC 3 μg/mL). No susceptibility to Vancomycin was identified among strains using the BMD method. According to the PAP-AUC method, it was confirmed that strain A3 was a heterogeneous VISA strain. Vancomycin Etest®, is a reliable screening test for VISA detection. Vancomycin BMD result was not in agreement with the Vancomycin Etest® result. PAP-AUC, the gold standard test used to detect Vancomycin resistance, should be conducted whenever possible for further confirmation and epidemiological record.

Keywords: Antibiotic resistance; hetero-VISA; MRSA; mecA; Staphylococcus aureus

ABSTRAK

Staphylococcus aureus rintang metisilin (MRSA) masih menjadi masalah klinikal global. Kejadian kerintangan terhadap strain Vankomisin MRSA menyebabkan kegagalan rawatan dan tempoh tinggal pesakit di hospital yang berpanjangan. Kajian ini dijalankan bagi mengenal pasti strain klinikal MRSA yang mempunyai penurunan kerentanan di sebuah hospital tertier di Malaysia. Strain Staphylococcus aureus diperoleh daripada pelbagai spesimen klinikal yang dikenal pasti secara fenotip. Ujian kerentanan terhadap antibiotik dijalankan dengan kaedah Kirby-Bauer. Strain (MRSA) disahkan oleh pengesanan gen mecA melalui tindak balas berantai polimerase (PCR), seterusnya penentuan kepekatan perencatan minimum Vankomisin (MIC) dijalankan melalui Etest®. Mikrodilusi kaldu (BMD) dijalankan bagi strain kerentanan pertengahan atau berkurangan. Selanjutnya, kerintangan disahkan oleh kawasan analisis populasi di bawah ujian keluk (PAP-AUC). Ujian penyebaran cakera menunjukkan semua strain (n = 105, 100%) rentan terhadap Rifampicin dan diikuti oleh Trimethoprim/Sulfamethoxazole. Walau bagaimanapun, kerintangan tinggi terhadap Penicillin (n = 93, 88.6%) ditunjukkan. Strain MRSA merangkumi 26.0% (n = 27) jumlah dikaji. Nilai MIC Vankomisin oleh Etest® dua strain (A3, A106) mempunyai kerentanan pertengahan (VISA) dan satu strain (A30) mempunyai pengurangan kerentanan terhadap Vankomisin dengan MIC 3 μg/mL. Tetapi, BMD tidak menunjukkan pengurangan kerentanan terhadap Vankomisin. Kaedah PAP-AUC mengesahkan bahawa strain A3 adalah hetero- Vankomisin pertengahan S. aureus (hVISA). Vankomisin Etest® adalah ujian saringan yang boleh dipercayai untuk pengesanan Vankomisin pertengahan S. aureus (VISA). Hasil mikrodilusi kaldu Vankomisin tidak sama dengan hasil Vankomisin Etest®. PAP-AUC sebagai ujian piawai menguji kerintangan terhadap Vankomisin disarankan bagi pengesahan tepat serta pengenalpastian epidemiologi kerintangan Vankomisin.

Kata kunci: Hetero-VISA; MRSA; mecA; rintangan antibiotik; Staphylococcus aureus

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*Corresponding author; email: tengkuzetty@upm.edu.my