CDC Reminds Clinical Laboratories and Healthcare Infection Preventionists of their Role in the Search and Containment of Vancomycin-Resistant Staphylococcus aureus (VRSA)

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January 2022 Update

The Centers for Disease Control and Prevention (CDC) has recently confirmed the 16th case of vancomycin-resistant Staphylococcus aureus (VRSA) infection since 2002 in the United States. This is the second confirmed case identified in the United States in 2021. The two cases identified in 2021 are not epidemiologically linked and reflect the emergence of VRSA in two distinct patients and locations. The last confirmed case in the United States prior to 2021 was identified in 2015.

This serves as a reminder about the important role of clinical laboratories in the diagnosis of VRSA cases to ensure prompt recognition, isolation, and management by infection control personnel. This is an important opportunity for all laboratories to revisit their step-by-step problem-solving procedure or algorithm for detecting VRSA that is specific for their laboratory. A sample algorithm is available and highlights the recommended testing methodologies for detecting VRSA and actions based on testing results.

Furthermore, because of exchange of genetic material from vancomycin-resistant enterococci (VRE) to methicillin-resistant Staphylococcus aureus (MRSA) in the emergence of VRSA, CDC is asking clinical laboratories, when patients are identified with suspected or confirmed VRSA, to ensure that all VRE, MRSA, and VRSA isolates from these patients are saved. Following confirmation of VRSA, CDC recommends that all three isolate types (i.e., VRE, MRSA, and VRSA) be shared with public health partners, including CDC.

Immediately, while performing confirmatory susceptibility tests, notify the patient’s primary caregiver, patient-care personnel, and infection-control personnel regarding the presumptive identification of VRSA so that appropriate infection control precautions can be initiated promptly. It is also important to notify local and state public health departments.

Coordination with public health authorities is critical. CDC has issued specific infection control recommendations intended to reduce the transmission of VRSA (Investigation and Control of Vancomycin-Resistant Staphylococcus aureus (VRSA): 2015 Update [PDF – 20 Pages]). Infection control precautions should remain in place until a defined endpoint has been determined in consultation with public health authorities.

VRSA infection continues to be a rare occurrence. A few existing factors seem to predispose case patients to VRSA infection, including:

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

Appropriate antimicrobial prescribing by healthcare providers, adherence to recommended infection control guidelines, and, ultimately, the control of both MRSA and VRE are necessary to prevent further emergence of VRSA strains.

Historical U.S. VRSA case count and geographical information:

Historical U.S. VRSA case count and geographical information:
Case State Year Age Source Diagnosis Underlying Conditions
1 MI 2002 40 Plantar ulcers and
Catheter tip		 Plantar soft tissue infection Diabetes, dialysis
2 PA 2002 70 Plantar ulcer Osteomyelitis Obesity
3 NY 2004 63 Urine from a nephrostomy tube No infection Multiple sclerosis, Diabetes, kidney stones
4 MI 2005 78 Toe wound Gangrene Diabetes, vascular disease
5 MI 2005 58 Surgical site wound after panniculectomy Surgical site infection Obesity
6 MI 2005 48 Plantar ulcer Osteomyelitis MVA, chronic ulcers
7 MI 2006 43 Triceps wound Necrotizing fasciitis Diabetes, dialysis, chronic ulcers
8 MI 2007 48 Toe wound Osteomyelitis Diabetes, obesity, chronic ulcers
9 MI 2007 54 Surgical site wound after foot amputation Osteomyelitis Diabetes, hepatic encephalopathy
10 MI 2009 53 Plantar foot wound Plantar soft tissue infection Diabetes, obesity, lupus, rheumatoid arthritis
11 DE 2010 64 Wound drainage Prosthetic joint infection Diabetes, end-stage renal disease, dialysis
12 DE 2010 83 Vaginal swab Vaginal discharge Chronic recurrent C. difficile infection, chronic UTIs, vesicoenteric fistula
13 DE 2012 70 Foot wound Chronic wound possible osteomyelitis Outpatient with chronic wound, hypertension, and diabetes mellitus
14 DE 2015 67 Toe wound Chronic wound Diabetes, end-stage renal disease requiring hemodialysis
15 MI 2021 88 Foot wound Chronic wound Diabetes, peripheral vascular disease, hypothyroidism, and anemia
16 NC 2021 55 Foot wound Chronic wound Diabetes, chronic lower extremity wounds

For frequently asked questions on laboratory testing on VRSA visit: Laboratory Detection of Vancomycin-Intermediate/Resistant Staphylococcus aureus (VISA/VRSA)

Additional Resources:

For assistance contact CDC’s Division of Healthcare Quality Promotion by e-mail at HAIoutbreak@cdc.gov.

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