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Future Microbiol. 2019 Feb 6. doi: 10.2217/fmb-2018-0346. [Epub ahead of print]

Reporting elevated vancomycin minimum inhibitory concentration in methicillin-resistant Staphylococcus aureus: consensus by an International Working Group.

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Leeds Teaching Hospitals NHS Trust & University of Leeds, Leeds, UK.
Microbiology Department, Security Forces Hospital, Riyadh, Saudi Arabia.
Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, Smolensk, Russia.
Infectious Diseases & Clinical Microbiology Department, National Institute of Respiratory Diseases, Mexico City, Mexico.
Hospital das Clínicas da Faculdade de Medicina, Seção de Microbiologia, Divisão de Laboratório Central LIM03, Universidade de São Paulo, São Paulo, Brazil.
Department of Medical Microbiology & Molecular Epidemiology, Pediatric Research & Clinical Center for Infectious Diseases, Department of Medical Microbiology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia.
Department of Clinical Microbiology, Royal University Hospital, Saskatchewan, Canada.


Methicillin-resistant Staphylococcus aureus (MRSA) remains an important cause of serious infection, for which vancomycin is often recommended as the first-choice antibiotic treatment. Appropriate vancomycin prescribing requires accurate measurement of minimum inhibitory concentrations (MICs) to avoid treatment failure, and yet determination can be challenging due to methodological difficulties associated with susceptibility testing. An International Working Group of infectious disease specialists and clinical/medical microbiologists reached a consensus that empirical MRSA infection therapies should be chosen regardless of the suspected origin of the infecting strain (e.g., community or hospital) due to the complex intermingling epidemiology of MRSA clones in these settings. Also, if an elevated vancomycin MIC in the susceptible range is obtained in routine testing, an alternative second method should be used for confirmation and to aid antibiotic therapy recommendations. There is no absolutely dependable method for the accurate determination of vancomycin MIC, but broth microdilution appears to be the most reliable.


CA-MRSA; HA-MRSA; minimum inhibitory concentration; susceptibility; vancomycin

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