On 2014 May 21, Emran Askari commented:

The Global Occurrence of VRSA as a Serious Public Health Concern

Zulfiqar Ali Mirani¹ , Emran Askari² , Zahra Moravvej²

¹ Microbiological Analytical Centre, PCSIR Laboratories Complex, Karachi ² Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

In their study, Rossi et al (Apr. 17 issue) [Rossi F, 2014] describe the presence of community-associated MRSA containing vanA as a serious public health concern. In such a comprehensive study, the authors should have considered a previous similar report of VRSA. Our report described the strain, CP2 which was isolated from the blood sample of a post-operative cardiac patient in Pakistan [Mirani ZA, 2013]. Similar to the study of Rossi et al, CP2 was also able to transfer vancomycin resistance trait to other staphylococci. It contained a Tn1546-like element without open reading frame 1 and an insertion sequence element similar to IS1216V [Mirani ZA, 2013]. Further studies showed that the strain belongs to agr type II and carries SCCmec type IV which is prevalent in community-associated MRSA (unpublished data).

The number of VRSA incidences has been the subject of our recent discussion [Moravvej Z, 2013]. Furthermore, considering the new VRSA reports from Portugal [Melo-Cristino J, 2013] and Brazil [Rossi F, 2014], it has now been reported from four continents. This warrants the need for continual monitoring of VRSA in order to predict the global occurrence of the “perfect storm” [Tenover FC, 2008].

On 2014 May 21, Emran Askari commented:

The Global Occurrence of VRSA as a Serious Public Health Concern

Zulfiqar Ali Mirani¹ , Emran Askari² , Zahra Moravvej²

¹ Microbiological Analytical Centre, PCSIR Laboratories Complex, Karachi ² Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

In their study, Rossi et al (Apr. 17 issue) [Rossi F, 2014] describe the presence of community-associated MRSA containing vanA as a serious public health concern. In such a comprehensive study, the authors should have considered a previous similar report of VRSA. Our report described the strain, CP2 which was isolated from the blood sample of a post-operative cardiac patient in Pakistan [Mirani ZA, 2013]. Similar to the study of Rossi et al, CP2 was also able to transfer vancomycin resistance trait to other staphylococci. It contained a Tn1546-like element without open reading frame 1 and an insertion sequence element similar to IS1216V [Mirani ZA, 2013]. Further studies showed that the strain belongs to agr type II and carries SCCmec type IV which is prevalent in community-associated MRSA (unpublished data).

The number of VRSA incidences has been the subject of our recent discussion [Moravvej Z, 2013]. Furthermore, considering the new VRSA reports from Portugal [Melo-Cristino J, 2013] and Brazil [Rossi F, 2014], it has now been reported from four continents. This warrants the need for continual monitoring of VRSA in order to predict the global occurrence of the “perfect storm” [Tenover FC, 2008].