Heterogeneous vancomycin-intermediate among methicillin resistant XXXX .

@entity20637 @entity794 @entity2286
BACKGROUND: Hetero-resistance vancomycin intermediate @entity794 ( @entity20637 ) is phenotype, which on in-vitro susceptibility test is vancomycin susceptible (VSSA) but has a minority population of vancomycin intermediate ( @entity20637 ). @entity20637 is responsible for vancomycin treatment failure. Population Analysis Profile- Area under Curve (PAP-AUC) is a test for detection of @entity20637 ; however, this test is unsuitable for clinical microbiology laboratory. Tests, such as Brain Heart Infusion Agar with 6   g/ml vancomycin (BHIA6V), E test and Macromethod E Test (MET) are available; however reported to have variable results. METHODS: 58 clinical isolates of Methicillin resistant @entity794 ( @entity794 ) having MIC of vancomycin more than 1   g/ml by E test and agar dilution were analyzed by PAP-AUC, BHIA6V and MET. RESULT: The prevalence of @entity20637 was 6.9%. @entity20637 isolates were having vancomycin E test MIC >2   g/ml. Sensitivity of BHIA6V, MET and E test with MIC >2   g/ml were 0.75, 0.67 and 1.0 respectively; however, positive predictive values ( @entity2286 ) were 0.43, 0.4 and 0.27 respectively with PAP-AUC. PAP-AUC ratio correlated with MIC by E test and MET. CONCLUSIONS: There is need for screening @entity794 isolates showing in-vitro vancomycin susceptibility  <=2   g/ml by agar dilution method for detection of @entity20637 . PAP-AUC test is unsuitable for routine laboratory testing. BHIA6V, MET and E test can be used for screening, however have low @entity2286 .
