Letter to the Editor

Beyond MRSA: The Growing Menace of hVISA and VISA

Authors: Deepti Bulchandani, MD, Jagdish Nachnani, MD, Curtis Fitzsimmons, MD, Paul Jost, MD, Joseph Brewer, MD

Abstract

To the Editor:


We would like to present the case of a 50-year-old black male admitted for a T11-T12 spinal abscess debridement. The patient had three admissions during the prior year with similar symptoms. During these admissions, his blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA), and his minimum inhibitory concentration (MIC) to vancomycin was 2. The patient was treated with vancomycin on his past admissions, and his blood cultures cleared. Intraoperatively, the patient showed osteomyelitis and diskitis, and cultures grew out MRSA with sensitivity to vancomycin with a MIC of 2. However, because his previous cultures had shown the same result and his infection had not cleared after nearly 12 months of intermittent treatment with vancomycin, the patient was suspected to have a heterogeneous vancomycin-intermediate S. aureus (hVISA) infection and was started on daptomycin. He responded promptly to daptomycin and his repeat blood cultures were negative. We believe that he probably had hVISA infection, as his infection was resistant to vancomycin, but quickly cleared up following treatment with daptomycin.

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References

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