ArticleJournal of clinical microbiology2011
Performance of various testing methodologies for detection of heteroresistant vancomycin-intermediate Staphylococcus aureus in bloodstream isolates.
Article in Journal of clinical microbiology, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
40 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Global trends and research profile of antibiotic heteroresistance: a bibliometric and visual analysis.Frontiers in microbiology · 2026Pooled it
- Pooled it
- High vancomycin minimum inhibitory concentration and clinical outcomes in adults with methicillin-resistant Staphylococcus aureus infections: a meta-analysis.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2013Pooled it
- Beyond antifungal susceptibility: molecular mechanisms, detection, and clinical implications of fungal heteroresistance.Molecular biology reports · 2026Review
- High prevalence of colistin heteroresistance in Pseudomonas aeruginosa bloodstream isolates and associated clinical factors.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- Beyond susceptibility results: understanding the clinical and diagnostic burden of bacterial heteroresistance.Molecular biology reports · 2026Review
- Evaluation of a simplified agar-based population analysis profiling as a practical alternative for detecting heteroresistance in clinical bacterial isolates.BMC infectious diseases · 2026Article
- Investigation of voriconazole heteroresistance in clinical isolates ofMicrobiology spectrum · 2025Article
- Multiomics analysis of Staphylococcus aureus ST239 strains resistant to virulent Herelleviridae phages.Scientific reports · 2024Article
- Reduced vancomycin susceptibility in Staphylococcus aureus clinical isolates: a spectrum of less investigated uncertainties.BMC infectious diseases · 2024Article
- Three concurrent mechanisms generate gene copy number variation and transient antibiotic heteroresistance.Nature communications · 2024Article
- Rates of resistance and heteroresistance to newer β-lactam/β-lactamase inhibitors for carbapenem-resistant Enterobacterales.JAC-antimicrobial resistance · 2024Article
- Antibiotic heteroresistance and persistence: an additional aid in hospital acquired infections byFuture microbiology · 2024Review
- Development of an Amplicon Nanopore Sequencing Strategy for Detection of Mutations Conferring Intermediate Resistance to Vancomycin in Staphylococcus aureus Strains.Microbiology spectrum · 2023Article
- Resistance and Molecular Characteristics of Methicillin-ResistantInfection and drug resistance · 2023Article
- An evaluation of 4 commercial assays for the detection of SARS-CoV-2 antibodies in a predominantly mildly symptomatic low prevalence Australian population.Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology · 2021Article
- A comparative study of heterogeneous antibiotic resistance of microbial populations in conventional periprosthetic tissue cultures and sonication fluid cultures of orthopaedics explanted prostheses.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2020Article
- Detection of heterogeneous vancomycin-intermediateThe Indian journal of medical research · 2019Article
- Mechanisms and clinical relevance of bacterial heteroresistance.Nature reviews. Microbiology · 2019Review
- The high prevalence of antibiotic heteroresistance in pathogenic bacteria is mainly caused by gene amplification.Nature microbiology · 2019Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The best screening method for detecting heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) remains unclear. Using population analysis profiling utilizing the area under the concentration-time curve (PAP-AUC) as the gold standard, we screened 458 consecutive methicillin-resistant S. aureus (MRSA) bloodstream isolates to determine the most accurate and cost-effective testing strategy to detect the presence of heteroresistance. All isolates were also tested using the macromethod Etest (MET) and glycopeptide resistance detection (GRD) Etest. The MIC was determined by several methods, including standard vancomycin Etest, vancomycin broth microdilution (BMD), and Vitek2 testing. Fifty-five (12%) hVISA and 4 (1%) VISA isolates were detected by PAP-AUC. Compared to PAP-AUC, the sensitivities and specificities of MET, GRD Etest, BMD (using a MIC cutoff of ≥ 2 mg/liter), and standard vancomycin Etest (using a MIC cutoff of ≥ 2 mg/liter) were 89 and 55%, 71 and 94%, 82 and 97%, and 71 and 94%, respectively. Combination testing increased the overall testing accuracy by reducing the number of false-positive results. Cost was determined predominately by the number of PAP-AUC runs required following a screening assay. The most cost-effective strategy was BMD (using a MIC cutoff of ≥ 2 μg/ml) as a standalone assay or in combination with PAP-AUC, provided that BMD testing was batched. GRD Etest remained an alternative, with 71% of hVISA isolates detected. Prevalence influenced both cost and test accuracy, with results remaining unchanged for hVISA prevalences of up to 25%. Implementation of any testing strategy would therefore be dependent on balancing cost with accuracy in a given population and clinical context.
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