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Vancomycin Resistance
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The page below is a sample from the LabCE course
Case Studies in Clinical Microbiology
. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.
Learn more about Case Studies in Clinical Microbiology (online CE course)
Vancomycin Resistance
Vancomycin and ampicillin resistance among
Enterococcus
species, particularly
E. faecium
have been on a steady increase.
The disk diffusion screening test is used in many laboratories to detect vancomycin resistant strains. Note in the upper image that no zone of inhibition is seen around either the vancomycin or the ampicillin disk, indicating resistance to both drugs.
Vancomycin-resistant Enterococci (VRE) have been divided into three phenotypes--Van A, Van B, and Van C.
Vancomycin-resistant strains of
E. faecalis
and
E. faecium
are commonly of the Van A phenotype, demonstrating high level resistance (MIC's higher than 64 ug/mL), as illustrated by total resistance of the test strain in the E test and the VA disk, as illustrated in the lower image.
The strain shown in the lower image, however, is ampicillin susceptible at the level of 1 ug/mL (see lower set of yellow arrows), indicating that this drug may be effective in treating the urinary tract infection.
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