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Reduced Vancomycin Susceptibility in Staphylococcus aureus , Including Vancomycin-Intermediate and Heterogeneous Vancomycin-Intermediate Strains: Resistance Mechanisms, Laboratory Detection, and Clinical Implications
Open accessAbstract
SUMMARY: The emergence of vancomycin-intermediate Staphylococcus aureus (VISA) and heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) over the past decade has provided a challenge to diagnostic microbiologists to detect these strains, clinicians treating patients with infections due to these strains, and researchers attempting to understand the resistance mechanisms. Recent data show that these strains have been detected globally and in many cases are associated with glycopeptide treatment failure; however, more rigorous clinical studies are required to clearly define the contribution of hVISA to glycopeptide treatment outcomes. It is now becoming clear that sequential point mutations in key global regulatory genes contribute to the hVISA and VISA phenotypes, which are associated predominately with cell wall thickening and restricted vancomycin access to its site of activity in the division septum; however, the phenotypic features of these strains can vary because the mutations leading to resistance can vary. Interestingly, changes in the staphylococcal surface and expression of agr are likely to impact host-pathogen interactions in hVISA and VISA infections. Given the subtleties of vancomycin susceptibility testing against S. aureus , it is imperative that diagnostic laboratories use well-standardized methods and have a framework for detecting reduced vancomycin susceptibility in S. aureus .
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In the citing paper
“Due to the difficulties on detecting these strains, vancomycin failures have been increasingly reported in deep-seated infections.”
From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [101]
In the citing paper
“Indeed, S. aureus within the range of susceptibility, with vancomycin MICs > 1 and ≤ 2 μg/ml have been more frequently associated with the hVISA phenotype.”
From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [101]
In the citing paper
“These global homeostatic changes appear to lead to a reduced autolytic activity with thickened cell wall and an increase amount of free D-Ala-D-Ala dipeptides with less peptidoglycan cross-linking (101, 104).”
From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [101]
In the citing paper
“Phenotypically, hVISA/VISA strains exhibit distinct metabolic characteristics that may include i) increase in fructose utilization, ii) increased fatty acid metabolism, iii) impaired acetate metabolism and tricarboxylic acid cycle, iv) decrease in glutamate availability, and iv) increase expression of cell wall synthesis genes.”
From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [101]
In the citing paper
“As the “resistant” subpopulation is difficult to identify, detection of hVISA becomes very challenging and some S. aureus strains reported as “susceptible” to vancomycin by standard susceptibility testing may still exhibit this phenotype (101).”
From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [101]
In the citing paper
“In addition, VISA strains bind vancomycin more avidly than their non –VISA counterparts, however, diffusion of the antibiotic molecule into the inner part of the cell wall appears to be impaired.”
From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [101]
In the citing paper
“Finally, a striking feature of many hVISA/VISA strains is the ability to revert from one phenotype to another (or even to a fully vancomycin susceptible phenotype) in the absence of vancomycin exposure.”
From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [101]
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Becker, K., Heilmann, C., & Peters, G. (2014) · Clinical Microbiology Reviews · doi:10.1128/cmr.00109-13 · Cited by 1,742
Methicillin-resistant Staphylococcus aureus
Lee, A. S., de LENCASTRE, H., Garau, J., Kluytmans, J. A. J. W., Malhotra‐Kumar, S., Peschel, A., & Harbarth, S. (2018) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2018.33 · Cited by 1,691
Metadata
- Authors
- Howden, B. P., Davies, J. K., Johnson, P. D. R., Stinear, T. P., & Grayson, M. L.
- Affiliations
- The University of Melbourne (AU)
- Monash University (AU)
- Venue
- Clinical Microbiology Reviews
- Publisher
- American Society for Microbiology
- Published
- 2010-01
- Volume
- 23
- Issue
- 1
- Pages
- 99-139
- ISSN
- 0893-8512 (ISSN-L)
- 1098-6618
- PMC
- PMC2806658
- OpenAlex
- W2126915534
- Cited by
- 962
- References
- 406
- Citations by year
- 2026: 42 · 2025: 41 · 2024: 48 · 2023: 58 · 2022: 45 · 2021: 52 · 2020: 49 · 2019: 60 · 2018: 54 · 2017: 51 · 2016: 63 · 2015: 83 · 2014: 69 · 2013: 88 · 2012: 72
- FWCI
- 9.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Microbiology Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
- Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
- Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
- Keywords
- vancomycin-intermediate Staphylococcus aureus, heterogeneous vancomycin-intermediate Staphylococcus aureus, reduced vancomycin susceptibility, glycopeptide resistance, cell wall thickening, agr gene, vancomycin susceptibility testing, treatment failure, host-pathogen interaction
- MeSH terms
- Anti-Bacterial Agents, Humans, Microbial Sensitivity Tests, Staphylococcal Infections, Staphylococcus aureus, Vancomycin, Treatment Outcome, Vancomycin Resistance
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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