Cited by 489Antibiotic Resistance in BacteriaAntimicrobial Resistance in StaphylococcusAntibiotic Use and Resistance

Antimicrobial heteroresistance: An emerging field in need of clarity

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El-Halfawy, Omar M., Valvano, Miguel A.·2015·Clinical Microbiology Reviews

Abstract

SUMMARY: “Heteroresistance” describes a phenomenon where subpopulations of seemingly isogenic bacteria exhibit a range of susceptibilities to a particular antibiotic. Unfortunately, a lack of standard methods to determine heteroresistance has led to inappropriate use of this term. Heteroresistance has been recognized since at least 1947 and occurs in Gram-positive and Gram-negative bacteria. Its clinical relevance may be considerable, since more resistant subpopulations may be selected during antimicrobial therapy. However, the use of nonstandard methods to define heteroresistance, which are costly and involve considerable labor and resources, precludes evaluating the clinical magnitude and severity of this phenomenon. We review the available literature on antibiotic heteroresistance and propose recommendations for definitions and determination criteria for heteroresistant bacteria. This will help in assessing the global clinical impact of heteroresistance and developing uniform guidelines for improved therapeutic outcomes.

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Crossref · 10.1128/cmr.00058-14

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169 of 169 references verified0 citation errors · 0 not checkable

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Authors
El-Halfawy, O. M., & Valvano, M. A.
Affiliations
Western University (CA)
Corresponding author
Valvano, Miguel A.
Venue
Clinical Microbiology Reviews
Published
2015-01
Volume
28
Issue
1
Pages
191-207
ISSN
  • 0893-8512 (ISSN-L)
  • 1098-6618
OpenAlex
W1980111518
Cited by
489
References
169
Citations by year
2026: 53 · 2025: 59 · 2024: 51 · 2023: 42 · 2022: 48 · 2021: 53 · 2020: 55 · 2019: 45 · 2018: 30 · 2017: 29 · 2016: 18 · 2015: 6
FWCI
1.93
Type
journal article
Language
en
Open access
Locations
  • Clinical Microbiology Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (Queen's University Belfast) (submittedVersion, other-oa)
Funders
  • Cystic Fibrosis Canada
  • Cystic Fibrosis Trust (PJ564)
  • British Society for Antimicrobial Chemotherapy
  • European Commission (618095)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
  • Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
Keywords
antimicrobial susceptibility testing, method standardization, Gram-positive bacteria, Gram-negative bacteria
MeSH terms
Anti-Bacterial Agents, Bacteria, Bacterial Infections, Drug Resistance, Bacterial

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