ArticleNature communications2025
Vancomycin heteroresistance (hVISA) in MRSA links to treatment failure and supports a revised PAP-AUC threshold.
Article in Nature communications, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
6 citing papers in PubMed.
- The efflux pump QacA mediates the transition to vancomycin heteroresistance in sequence type 5 methicillin-resistantEmerging microbes & infections · 2026Article
- Transcriptional regulation drives heteroresistance inmSystems · 2026Article
- Disruption of Functional Membrane Microdomains Enhances Methicillin-ResistantVeterinary sciences · 2026Article
- Profiling the gut resistome to unlock antimicrobial resistance biology and inform clinical risk.Nature communications · 2026Review
- Beyond susceptibility results: understanding the clinical and diagnostic burden of bacterial heteroresistance.Molecular biology reports · 2026Review
- [From cutaneous abscess to ventriculitis caused by Panton-Valentine leukocidin-positive methicillin-resistantRevista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2026Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
Heteroresistance to vancomycin among methicillin-resistant Staphylococcus aureus (MRSA) remains a diagnostic and therapeutic problem in clinical microbiology. In this prospective cohort study of 842 adult patients with MRSA bacteremia in S. Korea, we investigate the prevalence, risk factors, and clinical implications of the heteroresistant vancomycin-intermediate S. aureus (hVISA) phenotype. The hVISA phenotype is detected in 22% of cases. Multivariable regression analysis reveals strong positive associations between hVISA and hospital-acquired infection, prior anti-MRSA therapy, vancomycin exposure, and particularly vancomycin MIC (odds ratio 15.2 per 1 mg/L increase, p < 0.001). Strikingly, patients infected with hVISA strains have a lower 90-day mortality compared to those with fully susceptible strains (hazard ratio 0.66, p = 0.019), suggesting a possible trade-off between resistance and virulence. However, in hVISA strains treated with vancomycin, outcomes reverse: mortality more than doubled (HR 2.5, p < 0.001), bacteremia persisted longer, and relapse rates increased fivefold. Using maximally selected rank statistics, we identify a PAP-AUC threshold of 0.65 as the first clinically derived breakpoint predictive of mortality risk, providing an actionable definition of vancomycin heteroresistance. These findings underscore the clinical relevance of hVISA, and support routine testing for heteroresistance to inform treatment decisions.
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