Rapid and easy detection of low-level resistance to vancomycin in methicillin-resistant Staphylococcus aureus by matrix-assisted laser desorption ionization time-of-flight mass spectrometry

PLoS One. 2018 Mar 9;13(3):e0194212. doi: 10.1371/journal.pone.0194212. eCollection 2018.

Abstract

Vancomycin-intermediately resistant Staphylococcus aureus (VISA) and heterogeneous VISA (hVISA) are associated with treatment failure. hVISA contains only a subpopulation of cells with increased minimal inhibitory concentrations, and its detection is problematic because it is classified as vancomycin-susceptible by standard susceptibility testing and the gold-standard method for its detection is impractical in clinical microbiology laboratories. Recently, a research group developed a machine-learning classifier to distinguish VISA and hVISA from vancomycin-susceptible S. aureus (VSSA) according to matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) data. Nonetheless, the sensitivity of hVISA classification was found to be 76%, and the program was not completely automated with a graphical user interface. Here, we developed a more accurate machine-learning classifier for discrimination of hVISA from VSSA and VISA among MRSA isolates in Japanese hospitals by means of MALDI-TOF MS data. The classifier showed 99% sensitivity of hVISA classification. Furthermore, we clarified the procedures for preparing samples and obtaining MALDI-TOF MS data and developed all-in-one software, hVISA Classifier, with a graphical user interface that automates the classification and is easy for medical workers to use; it is publicly available at https://github.com/bioprojects/hVISAclassifier. This system is useful and practical for screening MRSA isolates for the hVISA phenotype in clinical microbiology laboratories and thus should improve treatment of MRSA infections.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Drug Resistance, Bacterial*
  • Humans
  • Methicillin-Resistant Staphylococcus aureus / classification
  • Methicillin-Resistant Staphylococcus aureus / drug effects*
  • Methicillin-Resistant Staphylococcus aureus / genetics
  • Microbial Sensitivity Tests / methods*
  • Software
  • Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization* / methods
  • Staphylococcal Infections / microbiology
  • Vancomycin / pharmacology*

Substances

  • Anti-Bacterial Agents
  • Vancomycin

Grants and funding

This work was supported by a grant-in-aid for the Center for Clinical Epidemiology, St. Luke’s International University (no grant number and URL, to Y.K.); by a Takeda Science Foundation Award (http://www.takeda-sci.or.jp/business/abroad_e.html, no grant number, to Y.K.); by a grant-in-aid (https://www.jsps.go.jp/english/e-grants/, 24791029 to Y.K. and 15K09581 to K.Y.) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan; and by the Foundation and Research Program on Emerging and Re-emerging Infectious Diseases from the Japan Agency for Medical Research and Development (AMED) (http://www.amed.go.jp/en/program, no grant number, to K.S.). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.