VRSA - First Case in Europe

Lost among the attention given to MERS in the recent NEJM and the H7N9 papers published in the Lancet today is a report of the first vancomycin-resistant S. aureus case in Europe. 

The case was in a 74yo in Portugal with diabetes on dialysis. She had prior pseudomonal and MRSA diabetic foot infections treated with vancomycin. This May she had VRSA detected in pus from a toe amputation wound with MIC for vancomycin of >256 μg/mL and MIC of 24μg/mL for teicoplanin. VRE and P. aeruginosa were also cultured. The VRSA strain was sequence type ST105, SCCmec type II, and had both the mecA and vanA genes (from her VRE). This VRSA was resistant to erythromycin, clindamycin, gentamicin, and ciprofloxacin, and susceptible to co-trimoxazole, tetracycline, tygecycline, linezolid, daptomycin, quinupristin/dalfopristin, fusidic acid, cloramphenicol, rifampicin, and mupirocin.