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September 17, 1997

Staphylococcus aureus With Reduced Susceptibility to Vancomycin—United States, 1997

JAMA. 1997;278(11):891-892. doi:10.1001/jama.1997.03550110029014

STAPHYLOCOCCUS aureus is one of the most common causes of both hospital- and community-acquired infections worldwide, and the antimicrobial agent vancomycin has been used to treat many S. aureus infections, particularly those caused by methicillinresistant S. aureus (MRSA). In 1996, the first documented case of infection caused by a strain of S. aureus with intermediate levels of resistance to vancomycin (VISA; minimum inhibitory concentration [MIC]=8 μg/mL) was reported from Japan.1 This report describes the first isolation of VISA from a patient in the United States, which may be an early warning that S. aureus strains with full resistance to vancomycin will emerge.

In July 1997, VISA-associated peritonitis was diagnosed in a patient who was being treated with long-term ambulatory peritoneal dialysis. During January 1996-June 1997, the patient had been treated with multiple courses of both intraperitoneal and intravenous vancomycin for repeated episodes of MRSA-associated peritonitis. The