Nosocomial infection of beta-lactam antibiotic-induced vancomycin-resistant Staphylococcus aureus (BIVR)

J Infect Chemother. 2006 Aug;12(4):181-4. doi: 10.1007/s10156-006-0455-x.


We report here an outbreak of beta-lactam-induced vancomycin-resistant methicillin-resistant Staphylococcus aureus (MRSA; BIVR) at one of the Cancer-Institute-affiliated hospitals in Tokyo. We examined a total of 500 strains (100 per year) of clinically isolated MRSA from 1998 to 2002. The detection rates of BIVR in the years 1998, 1999, 2000, 2001, and 2002 were 10%, 9%, 49%, 15%, and 19%, respectively. To investigate the cause of the high incidence of BIVR detection in the year 2000, we carried out pulsed-field gel electrophoresis (PFGE) of the SmaI-digested chromosomal DNA of BIVR and MRSA. The results showed that 96% of the BIVR strains isolated in 2000 were classified as an identical DNA type "A", while only 47% of the MRSA strains were classified as this type. We concluded, based on these results, that this hospital had a nosocomial infection of BIVR in the year 2000. An important message given by this study would be that nosocomial BIVR infection could occur in any hospital where MRSA infection is treated with vancomycin and beta-lactam antibiotics.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Cross Infection / drug therapy*
  • Cross Infection / epidemiology
  • Cross Infection / microbiology
  • DNA, Bacterial / analysis
  • Disease Outbreaks
  • Drug Resistance, Multiple, Bacterial
  • Drug Therapy, Combination
  • Electrophoresis, Gel, Pulsed-Field
  • Humans
  • Methicillin Resistance*
  • Staphylococcal Infections / drug therapy*
  • Staphylococcal Infections / epidemiology
  • Staphylococcal Infections / microbiology
  • Staphylococcus aureus / classification*
  • Staphylococcus aureus / genetics
  • Staphylococcus aureus / isolation & purification
  • Vancomycin Resistance*
  • beta-Lactams / therapeutic use*


  • Anti-Bacterial Agents
  • DNA, Bacterial
  • beta-Lactams