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The emergence of Staphylococcus aureus with reduced susceptibility to vancomycin in Japan

  • Keiichi Hiramatsu
    Correspondence
    Requests for reprints should be addressed to Keiichi Hiramatsu, MD, PhD, Department of Bacteriology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan 113
    Affiliations
    Department of Bacteriology, Juntendo University, Tokyo, Japan
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      Abstract

      Within the past year, infections caused by methicillin-resistant Staphylococcus aureus (MRSA) strains with reduced susceptibility to vancomycin (MIC = 8 μg/mL) have been reported in both Japan and the United States. The emergence of these strains poses a potentially serious threat to public health. After 2 such strains (Mu3 and Mu50) were identified at Juntendo Hospital in 1996, a screening program to identify MRSA strains with reduced susceptibility to vancomycin was initiated. Of 970 MRSA strains tested at 195 nonuniversity hospitals throughout Japan, 13 (1.3%) were found to have subpopulations with reduced vancomycin susceptibility (heterogeneous vancomycin resistance). Among 129 MRSA strains identified at 7 university hospitals, 12 (9.3%) demonstrated heterogeneity for vancomycin resistance; 1 of these strains had a vancomycin MIC of 7 μg/mL. Although resistance in these strains is not the result of the transfer of enterococcal vancomycin resistance genes (vanA or vanB), the clonal dissemination of MRSA strains with vancomycin-resistant subpopulations is obviously undesirable. Intensified testing of MRSA strains for resistance to vancomycin and appropriate measures for the prevention of the spread of such strains are recommended.
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