Vancomycin-Intermediate Staphylococcus aureus
In June 2000, vancomycin-intermediate Staphylococcus aureus (VISA) was isolated from a 27-year-old home health-care patient following a complicated cholecystectomy. Two VISA strains were identified with identical MICs to all antimicrobials tested except oxacillin and with closely related pulsed-field gel electrophoresis types. The patient was treated successfully with antimicrobial therapy, biliary drainage, and reconstruction. Standard precautions in the home health setting appear successful in preventing transmission.

To date, four of the eight cases of infection by Staphylococcus aureus with reduced susceptibility to vancomycin (vancomycin-intermediate S. aureus [VISA] or glycopeptide-intermediate S. aureus [GISA]) have been reported in the United States. We report a fifth case of VISA infection in the United States, and the first to occur during home health-care therapy. While all previous VISA strains have been oxacillin resistant, one of the two VISA strains identified in this investigation was oxacillin susceptible.