ArticleJournal of clinical microbiology2011
Detection of intermediately vancomycin-susceptible and heterogeneous Staphylococcus aureus isolates: comparison of Etest and Agar screening methods.
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 23 papers, 3 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- The global scope of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA): a meta-analysis of its clinical impact, molecular epidemiology, and diagnostic challenges across 15,165 isolates.BMC infectious diseases · 2026Pooled it
- Diagnostic value of BHI-V4 for heterogeneous and vancomycin-intermediate Staphylococcus aureus isolates: a systematic review and meta-analysis.BMC infectious diseases · 2024Pooled it
- Global prevalence and distribution of vancomycin resistant, vancomycin intermediate and heterogeneously vancomycin intermediate Staphylococcus aureus clinical isolates: a systematic review and meta-analysis.Scientific reports · 2020Pooled it
- Beyond antifungal susceptibility: molecular mechanisms, detection, and clinical implications of fungal heteroresistance.Molecular biology reports · 2026Review
- Beyond susceptibility results: understanding the clinical and diagnostic burden of bacterial heteroresistance.Molecular biology reports · 2026Review
- Droplet microfluidics with image texture quantification for detection of rare antibiotic-resistant subpopulations from bloodstream infections.NPJ digital medicine · 2026Article
- Article
- Attenuated total reflection: Fourier transform infrared spectroscopy for detection of heterogeneous vancomycin-intermediate Staphylococcus aureus.World journal of microbiology & biotechnology · 2020Article
- Vancomycin MIC Distribution among Methicillin-ResistantOpen access Macedonian journal of medical sciences · 2019Article
- Combination Antibiotic Exposure Selectively Alters the Development of Vancomycin Intermediate Resistance in Staphylococcus aureus.Antimicrobial agents and chemotherapy · 2018Article
- Rapid Detection of Heterogeneous Vancomycin-IntermediateFrontiers in microbiology · 2018Article
- Impact of Time to Appropriate Therapy on Mortality in Patients with Vancomycin-Intermediate Staphylococcus aureus Infection.Antimicrobial agents and chemotherapy · 2016Article
- Identification of Low-Level Vancomycin Resistance in Staphylococcus aureus in the Era of Informatics.Journal of clinical microbiology · 2016Article
- Rapid Detection of Vancomycin-Intermediate Staphylococcus aureus by Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry.Journal of clinical microbiology · 2016Article
- Screening for Intermediately Vancomycin-Susceptible and Vancomycin-Heteroresistant Staphylococcus aureus by Use of Vancomycin-Supplemented Brain Heart Infusion Agar Biplates: Defining Growth Interpretation Criteria Based on Gold Standard Confirmation.Journal of clinical microbiology · 2015Article
- Effects of Frozen Storage on Detection of Intermediate Vancomycin Susceptibility and Heteroresistance in Methicillin-Resistant Staphylococcus aureus Blood Isolates.Journal of clinical microbiology · 2015Article
- Antimicrobial heteroresistance: an emerging field in need of clarity.Clinical microbiology reviews · 2015Review
- Using genomics to standardize population analysis profile-area under the curve ratio for vancomycin-intermediate Staphylococcus aureus.Journal of clinical microbiology · 2014Article
- Reduced vancomycin susceptibility in porcine ST9 MRSA isolates.Frontiers in microbiology · 2013Article
- Article
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Detection of Staphylococcus aureus isolates with intermediate vancomycin susceptibility (VISA) and heteroresistance (hVISA) remains problematic. The population analysis profile/area under the curve (PAP/AUC) is the gold standard but is cumbersome. We compared the performance of two Etest screening methods (macromethod [MAC] and glycopeptide resistance detection [GRD]) plus brain heart infusion (BHI) agars supplemented with 3 (BHI-V3) or 4 (BHI-V4) mg/liter vancomycin in detecting hVISA and/or VISA phenotypes. Etest hVISA screenings were done in parallel for 485 saved methicillin-resistant S. aureus (MRSA) blood isolates according to the manufacturer's instructions. The PAP/AUC was measured for all isolates according to the modified method. PAP/AUC test isolate/Mu3 ratios of <0.9, 0.9 to 1.3, and >1.3 were considered positive for susceptible MRSA (S-MRSA), hVISA, and VISA, respectively. PAP/AUC revealed seven VISA and 33 hVISA phenotypes. MAC screening was positive for 30 (75.0%) hVISA/VISA and 49 (11.0%) S-MRSA isolates. GRD screening was positive for 28 (70.0%) hVISA/VISA and 63 (14.2%) S-MRSA isolates. Growth on BHI-V3 was noted in all hVISA/VISA and 24 (5.4%) S-MRSA isolates. Growth on BHI-V4 was noted in all VISA and four (12.1%) hVISA isolates. None of the S-MRSA isolates grew on BHI-V4 agar. The sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values were 75.0%, 89.0%, 38.0%, and 97.5% for MAC; 70.0%, 85.8%, 30.8%, and 97.0% for GRD; 100%, 94.6%, 62.5%, and 100% for BHI-V3; and 100, 99.2%, 63.6%, and 100% for BHI-V4 (for detecting VISA). These findings suggest that both Etest screening methods have excellent NPV, but positive results require confirmation. BHI-V3 and BHI-V4 agars provide more precise identification of hVISA and VISA, respectively; they may be reasonable alternatives to PAP/AUC.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.