Clinician Brief: Clinical Laboratories' and Infection Preventionists' Roles in the Search for and Containment of Vancomycin-Resistant Staphylococcus aureus

Key points

  • Clinical laboratories serve an important role in the diagnosis of vancomycin-resistant Staphylococcus aureus (VRSA) cases.
  • Laboratories should revisit their step-by-step problem-solving procedure or algorithm for detecting VRSA.
  • Clinical laboratories should save all Vancomycin-resistant Enterococci (VRE), Methicillin-resistant Staphylococcus aureus (MRSA) and VRSA isolates from patients with suspected or confirmed VRSA and share confirmed isolates with public health partners.

January 2022 Update

Clinical laboratories serve an important role in the diagnosis of VRSA cases to ensure prompt recognition, isolation and management by infection control personnel.

Because of genetic material exchanges from VRE to MRSA in the emergence of VRSA, CDC asks clinical laboratories to ensure they save all VRE, MRSA and VRSA isolates from patients with suspected or confirmed VRSA. Following confirmation of VRSA, CDC recommends that clinical laboratories share all three isolate types (i.e., VRE, MRSA and VRSA) with public health partners, including CDC.

Risk factors

VRSA infection continues to be a rare occurrence in the U.S. A few existing factors seem to make patients vulnerable to VRSA infection, including:

  • Prior MRSA and enterococcal infections or colonization.
  • Underlying conditions (such as chronic skin ulcers and diabetes).
  • Previous treatment with vancomycin.

Prevention

Actions to prevent further emergence of VRSA strains include:

  • Appropriate antibiotic prescribing by healthcare providers.
  • Adherence to recommended infection control guidelines.
  • Control of both MRSA and VRE.

Reporting and response

While performing confirmatory susceptibility tests, immediately notify the patient's primary caregiver, patient-care personnel and infection-control personnel of the presumptive identification of VRSA so healthcare personnel can initiate appropriate infection control precautions.

It is also critical to notify and coordinate with local and state public health departments and authorities. CDC has issued specific infection control recommendations intended to reduce the transmission of VRSA (Investigation and Control of Vancomycin-Resistant Staphylococcus aureus (VRSA): 2015 Update).

Infection control precautions should remain in place until a defined endpoint has been determined in consultation with public health authorities.

Disease trends

In 2021, the Centers for Disease Control and Prevention (CDC) confirmed the 16th case of VRSA infection in the United States. This was the second confirmed case identified in the United States in 2021. The two cases identified in 2021 are not epidemiologically linked and reflect the emergence of VRSA in two distinct patients and locations. The last confirmed case in the United States before 2021 was identified in 2015.

Historical U.S. VRSA case count and geographical information
State Year Age Source Diagnosis Underlying Conditions
MI 2002 40 Plantar ulcers and
Catheter tip		 Plantar soft tissue infection Diabetes, dialysis
PA 2002 70 Plantar ulcer Osteomyelitis Obesity
NY 2004 63 Urine from a nephrostomy tube No infection Multiple sclerosis, Diabetes, kidney stones
MI 2005 78 Toe wound Gangrene Diabetes, vascular disease
MI 2005 58 Surgical site wound after panniculectomy Surgical site infection Obesity
MI 2005 48 Plantar ulcer Osteomyelitis MVA, chronic ulcers
MI 2006 43 Triceps wound Necrotizing fasciitis Diabetes, dialysis, chronic ulcers
MI 2007 48 Toe wound Osteomyelitis Diabetes, obesity, chronic ulcers
MI 2007 54 Surgical site wound after foot amputation Osteomyelitis Diabetes, hepatic encephalopathy
MI 2009 53 Plantar foot wound Plantar soft tissue infection Diabetes, obesity, lupus, rheumatoid arthritis
DE 2010 64 Wound drainage Prosthetic joint infection Diabetes, end-stage renal disease, dialysis
DE 2010 83 Vaginal swab Vaginal discharge Chronic recurrent C. difficile infection, chronic UTIs, vesicoenteric fistula
DE 2012 70 Foot wound Chronic wound possible osteomyelitis Outpatient with chronic wound, hypertension, and diabetes mellitus
DE 2015 67 Toe wound Chronic wound Diabetes, end-stage renal disease requiring hemodialysis
MI 2021 88 Foot wound Chronic wound Diabetes, peripheral vascular disease, hypothyroidism, and anemia
NC 2021 55 Foot wound Chronic wound Diabetes, chronic lower extremity wounds

Resources

For assistance contact CDC's Division of Healthcare Quality Promotion by e-mail at HAIoutbreak@cdc.gov.

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)