Heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) in prosthetic joint infections: a case series and review

Brahman Sivakumar,1 Alex Chaudhuri,2 Praveen Vijaysegaran31Department of Orthopedic Surgery, Royal Brisbane and Women's Hospital, Herston, 2Department of Infectious Diseases, The Prince Charles Hospital, Chermside, 3Department of Orthopedic Surgery, The Prince Charles Hospital, Chermside, AustraliaAbstract: Prosthetic joint infections are notoriously difficult to manage and often result in prolonged antibiotic therapy, which has been identified as contributing to bacterial resistance. Heteroresistant vancomycin-intermediate Staphylococcus aureus is a substrain of methicillin-resistant Staphylococcus aureus associated with a higher affinity for bone and joint infections. Here, we present three cases of heteroresistant vancomycin-intermediate S. aureus prosthetic joint infection at our institution, review the literature, and provide recommendations for the management of such infections in the future.Keywords: vancomycin, antibiotics, resistance, orthopedics