ArticlePLoS biology2024
High prevalence of heteroresistance in Staphylococcus aureus is caused by a multitude of mutations in core genes.
Article in PLoS biology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis 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
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Global trends and research profile of antibiotic heteroresistance: a bibliometric and visual analysis.Frontiers in microbiology · 2026Pooled it
- Population size modulates the transition from gene amplification-mediated heteroresistance to stable resistance.npj antimicrobials and resistance · 2026Article
- Methicillin-resistant Staphylococcus aureus.Nature reviews. Disease primers · 2026Review
- Bacterial heteroresistance mechanisms, dynamics, and emerging diagnostic approaches.Bioscience reports · 2026Review
- Droplet microfluidics with image texture quantification for detection of rare antibiotic-resistant subpopulations from bloodstream infections.NPJ digital medicine · 2026Article
- Article
- Daptomycin failure in the treatment of Enterococcus faecium bacteremia: microbiological insights and the importance of dual therapy including beta-lactam.Critical care (London, England) · 2026Article
- Heteroresistance to amikacin inMicrobiology spectrum · 2026Article
- Article
- Preparation of culture plates demonstrating anti-Staphylococcus aureus activity of Penicillium sp. and their use as teaching materials.Access microbiology · 2026Article
- Vancomycin heteroresistance (hVISA) in MRSA links to treatment failure and supports a revised PAP-AUC threshold.Nature communications · 2025Article
- Evolution under vancomycin selection drives divergent collateral sensitivity patterns inProceedings of the National Academy of Sciences of the United States of America · 2025Article
- Methicillin-ResistantAntibiotics (Basel, Switzerland) · 2025Review
- Synergistic pathogenesis: exploring biofilms, efflux pumps and secretion systems in Acinetobacter baumannii and Staphylococcus aureus.Archives of microbiology · 2025Review
- Mechanisms ofInternational journal of molecular sciences · 2025Article
- Epidemiology, mechanisms, and clinical impact of bacterial heteroresistance.npj antimicrobials and resistance · 2025Review
- Mechanisms of Staphylococcus aureus Antibiotics Resistance Revealed by Adaptive Laboratory Evolution.Current microbiology · 2025Article
- Phenotypic Variation inAntibiotics (Basel, Switzerland) · 2024Review
- Theoretical considerations and empirical predictions of the pharmaco- and population dynamics of heteroresistance.Proceedings of the National Academy of Sciences of the United States of America · 2024Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
Abstract
Heteroresistance (HR) is an enigmatic phenotype where, in a main population of susceptible cells, small subpopulations of resistant cells exist. This is a cause for concern, as this small subpopulation is difficult to detect by standard antibiotic susceptibility tests, and upon antibiotic exposure the resistant subpopulation may increase in frequency and potentially lead to treatment complications or failure. Here, we determined the prevalence and mechanisms of HR for 40 clinical Staphylococcus aureus isolates, against 6 clinically important antibiotics: daptomycin, gentamicin, linezolid, oxacillin, teicoplanin, and vancomycin. High frequencies of HR were observed for gentamicin (69.2%), oxacillin (27%), daptomycin (25.6%), and teicoplanin (15.4%) while none of the isolates showed HR toward linezolid or vancomycin. Point mutations in various chromosomal core genes, including those involved in membrane and peptidoglycan/teichoic acid biosynthesis and transport, tRNA charging, menaquinone and chorismite biosynthesis and cyclic-di-AMP biosynthesis, were the mechanisms responsible for generating the resistant subpopulations. This finding is in contrast to gram-negative bacteria, where increased copy number of bona fide resistance genes via tandem gene amplification is the most prevalent mechanism. This difference can be explained by the observation that S. aureus has a low content of resistance genes and absence of the repeat sequences that allow tandem gene amplification of these genes as compared to gram-negative species.
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What OpenQuestion holds
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.