Vancomycin Intermediate Staphylococcus aureus (VISA) and Vancomycin Resistant Staphylococcus aureus (VRSA)

VISA and VRSA are specific types of the bacteria called Staphylococcus aureus that have become resistant to the antibiotic vancomycin. Staphylococcus aureus, often simply referred to as “staph”, are bacteria commonly found on the skin and in the nose of healthy people. Occasionally, staph can cause infection and is one of the most common causes of skin infections in the United States. 

VISA and VRSA are classified as “intermediate” or “resistant” based on lab tests. Similar to MRSA, it is spread through contact. VISA/VRSA infections are rare.

Symptoms of VISA/VRSA are not very different than that of a regular staph infection or even MRSA. Since VISA and VRSA are generally seen in people  with underlying health conditions a physician may first prescribe one antibiotic but need to change it later on once they know the patient has VISA/VRSA.

The following are things that people with VRSA seem to have in common:

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

You can follow the same prevention measures for VISA and VRSA that you would use with MRSA.

• Keep your hands clean by washing with soap and water or using an alcohol-based hand sanitizer.
• Always tell your healthcare provider if you have ever had MRSA, VISA or VRSA.
• Avoid contact with other people's wounds or items contaminated from wounds.

VISA infections are rare in children. In the event of a suspected case, increased hand cleaning, for both staff and students is recommended. Using soaps that contain an ingredient called “chlorhexidine” or alcohol-based hand rubs are recommended. Unless directed by a physician, students with any type of staph infection (MRSA/VISA/VRSA) need to be excluded from attending school until drainage from wounds or skin and soft tissue infections is contained and maintained in a clean dry bandage; restrict from situations that could result in the infected area becoming exposed, wet, soiled, or otherwise compromised.

To date, zero VRSA cases have been reported to the Texas Department of State Health Services. There have been VISA cases reported in various areas of Texas. In 2016, there were 13 reported VISA cases. These VISA cases have remained susceptible to currently available antibiotics. Since both VRSA and VISA are still uncommon, any suspected cases should be immediately reported to the appropriate health department. Isolates should be sent to DSHS Laboratory for confirmatory testing.

 

Cases of Vancomycin Intermediate Staphylococcus aureus (VISA) and Vancomycin Resistant Staphylococcus aureus (VRSA) should be reported immediately to the local or regional health department. If jurisdiction is unclear, call the DSHS HAI Epidemiologist or Emerging and Acute Infectious Disease Branch (EAIDU) at 512-776-7676 for assistance.

As required by the Texas Administrative Code (TAC), all Staphylococcus aureus isolates with a vancomycin MIC greater than 2 μg/ml must be submitted to the DSHS Laboratory (the laboratory can be reached at 512-776-7318).

• Texas Department of State Health Services
  Laboratory Services Section
  1100 West 49th Street
  Austin, Texas 78756-3199

All reports of VISA and VRSA shall include patient name, date of birth or age, sex, city of submitter, anatomic site of culture, date of culture, and minimum inhibitory concentration (MIC) if available.

• Investigation Guidance | IDPS (DSHS)
• Vancomycin-intermediate and Vancomycin-resistant Staphylococcus aureus (VISA/VRSA) | CDC