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Background  Vancomycin is still one of the most commonly used drug for treatment of severe methicillin-resistant  Staphylococcus aureus  (MRSA) infections. Vancomycin-resistant  S. aureus  (VRSA) strains are a serious danger for public health. This study aimed to characterize healthcare-associated MRSA (HA-MRSA) strains, resistant to at least one of glycopeptide antibiotics: vancomycin (VRSA) and/or teicoplanin (TRSA), isolated at three Warsaw hospitals over a period of 17-years (1991–2007).    Methods  Among 600 HA-MRSA strains, isolated from patients with symptomatic infections, 47 were subjected to detailed analysis. In the study, mechanisms behind VRSA phenotypes were determined (E-tests, GRD-test, agar-dilution method and  van A/B detection). Characteristics of selected isolates on molecular level: i) by detection of resistance genes  erm A/ erm B/ erm C,  msr A/ msr B,  lin A/ lin A’,  aac A- aph D,  aad D,  aph (3”)-IIIa; ii) SCC mec -typing and iii) MLST-typing was done.    Results  In general population of studied strains, 11/47 (23.4%) were VRSA and 36/47 (76.6%) were resistant only to teicoplanin. All isolates exhibited  van -independent mechanisms of resistance. Over 80% of isolates belonged to clonal complex CC8, with the following predominant sequence types (STs)/clones: ST247-IA/Iberian, ST241-III/Finland-UK, and ST239-III/Brazilian. Most of the isolated strains harboured  erm A and  aac A- aph D genes, encoding additional resistance to macrolides, lincosamides, streptogramin B, and majority of aminoglycosides. They occurred also in Polish VRSA/TRSA population over the period, which was subjected for analysis: an increase in MIC values for glycopeptides, evolution in terms of the level and extent of resistance, and genetic re-assortment in epidemic clones.    Conclusions  VRSA strains isolated from patients hospitalized at three Warsaw teaching hospitals in Poland, over a period of 17-years do not pose a threat as potential donors of  van  genes in horizontal-gene transfer processes, but are constantly evolving and represent international epidemic clones.

Characteristics of glycopeptide-resistant Staphylococcus aureus strains isolated from inpatients of three teaching hospitals in Warsaw, Poland