The mechanism of glycopeptide resistance in GISA isolates has not been discovered, but appears to be related to alterations in cell-wall synthesis. Indwelling catheters should be removed and any potential source of infection drained. Antibiotic therapy should be based on invitro susceptibility tests. Any treatment decisions should be made in conjunction with infectious disease consultation. The role of the microbiology laboratory is essential.
Appropriate laboratory screening for vancomycin susceptibility is critical.
Surveillance should be performed in patients with documented MRSA infections, especially if they have received long-term vancomycin therapy with additional emphasis in the HD and CAPD populations. Reduced susceptibility of Staphylococcus aureus to vancomycin- Japan, 1996. Interim Guidelines for prevention and control of Staphylococcal infection associated with reduced susceptibility to vancomycin. Staphylococcus aureus with reduced susceptibility to vancomycin-United States, 1997. Staphylococcus aureus with reduced susceptibility to vancomycin- United States, 1997.