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CDC Reminds Clinical Laboratories and Healthcare Infection Preventionists of their Role in the Search and Containment of Vancomycin-Resistant Staphylococcus aureus (VRSA)

The Centers for Disease Control and Prevention (CDC) has recently confirmed the 13th case of vancomycin resistant Staphylococcus aureus (VRSA) infection since 2002 in the United States. This serves as a reminder about the important role of clinical laboratories in the diagnosis of VRSA cases to ensure prompt recognition, isolation, and management by infection control personnel. This is an important opportunity for all laboratories to revisit their step-by-step problem-solving procedure or algorithm for detecting VRSA that is specific for their laboratory. A sample algorithm is available and highlights the recommended testing methodologies for detecting VRSA and actions based on testing results.

Furthermore, because of exchange of genetic material from vancomycin-resistant enterococci (VRE) to methicillin-resistant Staphylococcus auerus (MRSA) in the emergence of VRSA, CDC is asking clinical laboratories, when patients are identified with suspected or confirmed VRSA, to ensure that all VRE, MRSA, and VRSA isolates from these patients are saved. Following confirmation of VRSA, CDC recommends that all three isolate types (i.e., VRE, MRSA, and VRSA) be shared with public health partners, including CDC.

Immediately, while performing confirmatory susceptibility tests, notify the patient's primary caregiver, patient-care personnel, and infection-control personnel regarding the presumptive identification of VRSA so that appropriate infection control precautions can be initiated promptly. It is also important to notify local and state public health departments.

Coordination with public health authorities is critical. CDC has issued specific infection control recommendations intended to reduce the transmission of VRSA. However, these may need to be customized to the healthcare settings (e.g., dialysis, home healthcare). Infection control precautions should remain in place until a defined endpoint has been determined in consultation with public health authorities.

VRSA infection continues to be a rare occurrence. A few existing factors seem to predispose case patients to VRSA infection, including:

  • Prior MRSA and enterococcal infections or colonization
  • Underlying conditions (such as chronic skin ulcers and diabetes)
  • Previous treatment with vancomycin

Appropriate antimicrobial prescribing by healthcare providers, adherence to recommended infection control guidelines, and, ultimately, the control of both MRSA and VRE are necessary to prevent further emergence of VRSA strains.

Historical U.S. VRSA case count and geographical information:

Case

State

Year

Age

Source

Diagnosis

Underlying Conditions

1

MI

2002

40

Plantar ulcers and
Catheter tip

Plantar soft tissue infection

Diabetes, dialysis

2

PA

2002

70

Plantar ulcer

Osteomyelitis

Obesity

3

NY

2004

63

Urine from a nephrostomy tube

No infection

Multiple sclerosis, Diabetes, kidney stones

4

MI

2005

78

Toe wound

Gangrene

Diabetes, vascular disease

5

MI

2005

58

Surgical site wound after panniculectomy

Surgical site infection

Obesity

6

MI

2005

48

Plantar ulcer

Osteomyelitis

MVA, chronic ulcers

7

MI

2006

43

Triceps wound

Necrotizing fasciitis

Diabetes, dialysis, chronic ulcers

8

MI

2007

48

Toe wound

Osteomyelitis

Diabetes, obesity, chronic ulcers

9

MI

2007

54

Surgical site wound after foot amputation

Osteomyelitis

Diabetes, hepatic encephalopathy

10

MI

2009

53

Plantar foot wound

Plantar soft tissue infection

Diabetes, obesity, lupus, rheumatoid arthritis

11

DE

2010

64

Wound drainage

Prosthetic joint infection

Diabetes, end-stage renal disease, dialysis

12

DE

2010

83

Vaginal swab

Vaginal discharge

Chronic recurrent C. difficile infection, chronic UTIs, vesicoenteric fistula

13

DE

2012

70

Foot wound

Chronic wound possible osteomyelitis

Outpatient with chronic wound, hypertension, and diabetes mellitus

For frequently asked questions on laboratory testing on VRSA visit: Laboratory Detection of Vancomycin-Intermediate/Resistant Staphylococcus aureus (VISA/VRSA)

Link to Recommendations for Preventing the Spread of Vancomycin Resistance Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC) or Siegel JD, Rhinehart E, Jackson M, et al. The Healthcare Infection Control Practices Advisory Committee (HICPAC). Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006

For assistance contact CDC's Division of Healthcare Quality Promotion by telephone 800-893-0485.

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