Original Article

MIC trends of vancomycin and teicoplanin among methicillin resistant CoNS isolates from new born blood cultures in a tertiary care centre in Southern India

Abstract

Background and Objectives: Coagulase-negative-Staphylococci (CoNS) are important etiological agent of bacteraemia in newborn babies. Methicillin resistant CoNS infections have only limited treatment options. The antimicrobial susceptibility pattern of Methicillin Resistant CoNS isolates from newborn blood cultures was studied with special reference to MICs of Vancomycin and Teicoplanin.
Materials and Methods: The study population included Methicillin Resistant Coagulase Negative Staphylococcal isolates (MRCoNS) from newborn blood cultures, during a one-year period. Minimum inhibitory concentration (MIC) of Vancomycin and Teicoplanin in Methicillin resistant CoNS isolates was determined by macrobroth dilution method as per CLSI guidelines and by automated methods.
Results: Coagulase Negative Staphylococci were the etiological agent in 73.7% (n-56) cases of neonatal bacteremia. Methicillin resistance in newborn CoNS was found to be 58.9%. All the MRCoNS isolates had vancomycin and teicoplanin MICs in the susceptible range. There were MRCoNS isolates with MICs in the upper limit of susceptible range for both vancomycin and teicoplanin, which can result in poor clinical response.
Conclusion: Continuous large scale multi-centre surveillance studies with special attention to study the MIC pattern of the high-end anti-MRSA agents like vancomycin, teicoplanin, linezolid are to be carried out. This will help the clinicians to judiciously prescribe the antibiotics, which is very essential for antimicrobial stewardship.

1. Dendi FZ, Allem R, Sebaihia M, Bensefia S, Cheurfa M, Alamir H, et al. Prevalence and molecular detection of Staphylococcus aureus resistance to antibiotics. Medicine (Baltimore) 2024; 103(24): e38562.
2. Shorman MA, Atoom AM, Abuharfeil NM, Al-Majali AM. Identification of methicillin resistant Staphylococcus aureus (MRSA) and methicillin resistant coagulase negative Staphylococci (CoNS) in clinical settings. Am J Infect Dis 2008; 4: 156-161.
3. Patel AK, Patel KK, Patel KR, Shah S, Dileep P. Time trends in the epidemiology of microbial infections at a tertiary care center in west India over last 5 years. J Assoc Physicians India 2010; 58 Suppl: 37-40.
4. Gopalakrishnan R, Sureshkumar D. Changing trends in antimicrobial susceptibility and hospital acquired infections over an 8 year period in a tertiary care hospital in relation to introduction of an infection control programme. J Assoc Physicians India 2010; 58 Suppl: 25-31.
5. Dhand A, Sakoulas G. Reduced vancomycin susceptibility among clinical Staphylococcus aureus isolates (‘the MIC creep’): Implications for therapy. F1000 Med Rep 2012; 4: 4.
6. Menezes GA, Harish BN, Sujatha S, Vinothini K, Parija SC. Emergence of vancomycin- intermediate Staphylococcus species in Southern India. J Med Microbiol 2008; 57: 911-912.
7. Rybak MJ, Lomaestro BM, Rotschafer JC, Moellering RC, Craig WA, Billeter M, et al. Vancomycin therapeutic guideline. A summary of consensus recommendation from infectious disease society of America, the American society of health system pharmacists and the society of infectious diseases pharmacists. Clin Infect Dis 2009; 49: 325-327.
8. Jones RN. Microbiological features of vancomycin in the 21stcentury: minimum inhibitory concentration creep, bactericidal/static activity, and applied breakpoints to predict clinical outcomes or detect resistant strains. Clin Infect Dis 2006; 42 Suppl 1: S13-S24.
9. CLSI (2018). Performance Standards for Antimicrobial Susceptibility Testing. 28th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute. https://clsi.org/standards/products/microbiology/documents/m100/
10. Clinical and Laboratory Standards Institute (2018). Methods for Dilution antimicrobial susceptibility test for bacteria that grow aerobically; Approved Standard. 11th ed. CLSI M07. Clinical and Laboratory Standards Institute, Wayne, PA.
11. Qazi SA, Stoll BJ. Neonatal sepsis: a major global public health challenge. Pediatr Infect Dis J 2009; 28(1 Suppl): S1-S2.
12. UNICEF, The State of the World’s Health 2009: Maternal and Newborn Health. https://www.unicef.org/media/84866/file/SOWC-2009.pdf
13. Otto M. Molecular basis of Staphylococcus epidermidis infections. Semin Immunopathol 2012; 34: 201-214.
14. Li X, Ding X, Shi P, Zhu Y, Huang Y, Li Q, et al. Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children's hospital, 2013 to 2017. Medicine (Baltimore) 2019; 98(12): e14686.
15. Singh S, Dhawan B, Kapil A, Kabra SK, Suri A, Sreenivas V, et al. Coagulase-negative staphylococci causing blood stream infection at an Indian tertiary care hospital: Prevalence, antimicrobial resistance and molecular characterization. Indian J Med Microbiol 2016; 34: 500-505.
16. Asangi SY, Mariraj J, Sathyanarayanan MS, Nagabhushan, Rashmi. Speciation of clinically significant coagulase negative staphylococci and their antibiotic resistant pattern in a tertiary care hospital. Int J Biol Med Res 2011; 2: 735-739.
17. Bora P, Datta P, Gupta V, Singhal L, Chander J. Characterization and antimicrobial susceptibility of coagulase-negative staphylococci isolated from clinical samples. J Lab Physicians 2018; 10: 414-419.
18. Mashaly GE, El-Mahdy RH. Vancomycin heteroresistance in coagulase negative Staphylococcus blood stream infections from patients of intensive care units in Mansoura University Hospitals, Egypt. Ann Clin Microbiol Antimicrob 2017; 16: 63.
19. Hope R, Livermore DM, Brick G, Lillie M, Reynolds R; BSAC Working Parties on Resistance Surveillance. Non-susceptibility trends among staphylococci from bacteremias in the UK and Ireland, 2001-06. J Antimicrob Chemother 2008; 62 Suppl 2: ii65-74.
20. Jacob JT, Diaz Granados CA. High vancomycin minimum inhibitory concentration and clinical outcomes in adults with methicillin resistant Staphylococcus aureus infections: a meta-analysis. Int J Infect Dis 2013; 17(2): e93-e100.
21. Van Hal SJ, Lodise TP, Paterson DL. The clinical significance of vancomycin minimum inhibitory concentration in Staphylococcus aureus infections: a systematic review and meta-analysis. Clin Infect Dis 2012; 54: 755-771.
22. Kuti JL, Kiffer CR, Mendes CM, Nicolau DP. Pharmacodynamic comparison of linezolid, teicoplanin and vancomycin against clinical isolates of Staphylococcus aureus and coagulase negative staphylococci collected from hospitals in Brazil. Clin Microbiol Infect 2008; 14: 116-123.
Files
IssueVol 16 No 5 (2024) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v16i5.16792
Keywords
Staphylococci; Sepsis; Vancomycin; Teicoplanin; Minimum inhibitory concentration
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
John N, Sajeev C, Hareendranath G, Mampilly T, Varghese A, Justus L. MIC trends of vancomycin and teicoplanin among methicillin resistant CoNS isolates from new born blood cultures in a tertiary care centre in Southern India. Iran J Microbiol. 2024;16(5):598-604.