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VISA — SCE Infectious Diseases MCQ

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HardAntimicrobial StewardshipVISASCE Infectious Diseases

A microbiology laboratory reports a blood culture isolate of Staphylococcus aureus with Vancomycin MIC of 4 mg/L. This is classified as Vancomycin-intermediate S. aureus (VISA). What is the most appropriate alternative antibiotic for this bloodstream infection?

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Correct answer: E — Daptomycin 8–10 mg/kg IV daily

VISA (Vancomycin MIC 4–8 mg/L per EUCAST) should NOT be treated with Vancomycin as clinical failure rates are high. Daptomycin at high dose (8–10 mg/kg daily) is the preferred alternative for VISA bacteraemia. CPK should be monitored weekly for rhabdomyolysis. Linezolid is bacteriostatic and not recommended for bacteraemia. Ceftaroline (anti-MRSA cephalosporin) is an emerging option, sometimes used in combination with Daptomycin for persistent MRSA/VISA bacteraemia.

Reference: BSAC 2023 – MRSA/VISA guidelines; EUCAST 2024 – Clinical breakpoints