Heteroresistant vancomycin intermediate S. aureus (h-VISA) isolated from a patient with orthopedic implant infection treated with glycopeptides: A case report

Abstract

A 37-year old male patient who had and orthopedic implant after a traffic accident,presented to the Infectious Diseases Clinic. He was accepted as culturenegative surgical site infection. Initial empirical treatment was started with clindamycinand then it was changed to the glycopeptides. During the follow-up,implant was removed. Intraoperative culture specimens revealed MethicillineResistant Staphylococcus aureus (S. aureus). After antibiotic therapy, total hipprosthesis was implanted and was removed for two times. Wound discharge wascontinued despite restarted the antibiotic treatment and growth of heteroresistant-Vancomycin intermediate S. aureus was detected in the aspiration culture.All isolates shared the same clonal properties by pulsed-field gel electrophoresis.The strain was negative for Panton-Valentine-Leucosidine and were shownto carry carried a Staphylococcal Cassette Chromosome mec type–III variantcommon. After a follow-up lasting eight years, the patient chose to continue hislife without prostheses (Girdlestone method). This case was reported for emphasizinghow difficult to manage medical treatment of prosthesis infections with developing resistant bacteria and the how important the surgical treatment was.