Antimicrobial heteroresistance: An emerging field in need of clarity
Open accessAbstract
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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Cites
Bacterial biofilms: from the Natural environment to infectious diseases
Hall‐Stoodley, L., Costerton, J. W., & Stoodley, P. (2004) · Nature Reviews Microbiology · doi:10.1038/nrmicro821 · Cited by 7,133 · see citing works
Antibiotic resistance threats in the United States, 2019
(U.S.), C. F. D. C. A. P. (2019) · doi:10.15620/cdc:82532 · Cited by 5,782 · see citing works
Physiological heterogeneity in biofilms
Stewart, P. S., & Franklin, M. J. (2008) · Nature Reviews Microbiology · doi:10.1038/nrmicro1838 · Cited by 2,480 · see citing works
Molecular Mechanisms of Antibacterial Multidrug Resistance
Alekshun, M. N., & Levy, S. B. (2007) · Cell · doi:10.1016/j.cell.2007.03.004 · Cited by 1,648 · see citing works
Pathophysiology and Management of Pulmonary Infections in Cystic Fibrosis
Gibson, R. L., Burns, J. L., & Ramsey, B. W. (2003) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200304-505so · Cited by 1,629 · see citing works
Hiramatsu, K., Aritaka, N., Hanaki, H., Kawasaki, S., Hosoda, Y., Hori, S., Fukuchi, Y., & Kobayashi, I. (1997) · The Lancet · doi:10.1016/s0140-6736(97)07324-8 · Cited by 1,333 · see citing works
Indole as an intercellular signal in microbial communities
Lee, J.-H., & Lee, J. (2010) · FEMS Microbiology Reviews · doi:10.1111/j.1574-6976.2009.00204.x · Cited by 1,059 · see citing works
Pseudomonas biofilm formation and antibiotic resistance are linked to phenotypic variation
Drenkard, E., & Ausubel, F. M. (2002) · Nature · doi:10.1038/416740a · Cited by 997 · see citing works
ENZYME INDUCTION AS AN ALL-OR-NONE PHENOMENON
Novick, A., & Weiner, M. (1957) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.43.7.553 · Cited by 891 · see citing works
Moffatt, J. H., Harper, M., Harrison, P. F., Hale, J. D. F., VINOGRADOV, E. V., Seemann, T., Henry, R., Crane, B., Michael, F. S., Cox, A. D., et al. (2010) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00834-10 · Cited by 817 · see citing works
Bacterial charity work leads to population-wide resistance
Lee, H. H., Molla, M. N., Cantor, C. R., & Collins, J. J. (2010) · Nature · doi:10.1038/nature09354 · Cited by 638 · see citing works
Cannibalism by sporulating bacteria.
González-Pastor, J. E., Hobbs, E. C., & Losick, R. (2003) · Science · doi:10.1126/science.1086462 · Cited by 579 · see citing works
Heteroresistance to Colistin in Multidrug-Resistant Acinetobacter baumannii
Li, J., Rayner, C. R., Nation, R. L., Owen, R. J., Spelman, D., Tan, K. E., & Liolios, L. (2006) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00103-06 · Cited by 549 · see citing works
Non-genetic individuality: chance in the single cell
Spudich, J. L., & Koshland, D. E. (1976) · Nature · doi:10.1038/262467a0 · Cited by 522 · see citing works
Charles, P. G. P., Ward, P. B., Johnson, P. D. R., Howden, B. P., & Grayson, M. L. (2004) · Clinical Infectious Diseases · doi:10.1086/381093 · Cited by 384 · see citing works
Eagle, H., & Musselman, A. D. (1948) · The Journal of Experimental Medicine · doi:10.1084/jem.88.1.99 · Cited by 378 · see citing works
Howden, B. P., McEvoy, C. R. E., Allen, D. L., Chua, K., Gao, W., Harrison, P. F., Bell, J. M., Coombs, G. W., Bennett-Wood, V. R., Porter, J. L., et al. (2011) · PLoS Pathogens · doi:10.1371/journal.ppat.1002359 · Cited by 371 · see citing works
McGuire, S. (2014) · Advances in Nutrition · doi:10.3945/an.114.005900 · Cited by 365 · see citing works
Sakoulas, G., Eliopoulos, G. M., Moellering, R. C., Wennersten, C. B., Venkataraman, L., Novick, R. P., & Gold, H. S. (2002) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.46.5.1492-1502.2002 · Cited by 364 · see citing works
The importance of being persistent: heterogeneity of bacterial populations under antibiotic stress
Gefen, O., & Balaban, N. Q. (2009) · FEMS Microbiology Reviews · doi:10.1111/j.1574-6976.2008.00156.x · Cited by 313 · see citing works
Expression of methicillin resistance in heterogeneous strains of Staphylococcus aureus
Hartman, B. J., & Tomasz, A. (1986) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.29.1.85 · Cited by 265 · see citing works
Sakoulas, G., Alder, J. D., Thauvin-Eliopoulos, C., Moellering, R. C., & Eliopoulos, G. M. (2006) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.50.4.1581-1585.2006 · Cited by 262 · see citing works
Keloids: Pathophysiology and management
Robles, D. T., Moore, E. C., Draznin, M., & Berg, D. (2007) · Dermatology Online Journal · doi:10.5070/d32m43548r · Cited by 248 · see citing works
New strategies for combating multidrug-resistant bacteria
Wright, G. D., & Sutherland, A. D. (2007) · Trends in Molecular Medicine · doi:10.1016/j.molmed.2007.04.004 · Cited by 244 · see citing works
Lo-Ten-Foe, J. R., de Smet, A. M. G. A., Diederen, B. M. W., Kluytmans, J. A. J. W., & van Keulen, P. H. J. (2007) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01406-06 · Cited by 242 · see citing works
Wu, S., de LENCASTRE, H., & Tomasz, A. (1996) · Journal of Bacteriology · doi:10.1128/jb.178.20.6036-6042.1996 · Cited by 241 · see citing works
An RpoB Mutation Confers Dual Heteroresistance to Daptomycin and Vancomycin in Staphylococcus aureus
Cui, L., Isii, T., Fukuda, M., Ochiai, T., Neoh, H., Camargo, I. L. B. D. C., Watanabe, Y., Shoji, M., Hishinuma, T., & Hiramatsu, K. (2010) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00437-10 · Cited by 207 · see citing works
Moffatt, J. H., Harper, M., Adler, B., et al. (2011) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01732-10 · Cited by 199 · see citing works
Salmonella typhimurium intercepts Escherichia coli signaling to enhance antibiotic tolerance
Vega, N. M., Allison, K. R., Samuels, A. N., Klempner, M. S., & Collins, J. J. (2013) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1308085110 · Cited by 185 · see citing works
Colistin Heteroresistance in Acinetobacter and Its Association with Previous Colistin Therapy
Hawley, J. S., Murray, C. K., & Jorgensen, J. H. (2007) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00766-07 · Cited by 183 · see citing works
Bacteremia Caused by Staphylococci with Inducible Vancomycin Heteroresistance
Wong, S. S. Y., Ho, P., Woo, P. C. Y., & Yuen, K. (1999) · Clinical Infectious Diseases · doi:10.1086/520429 · Cited by 165 · see citing works
CHARACTERISTICS OF METHICILLIN-RESISTANT STAPHYLOCOCCI
Sutherland, R., & Rolinson, G. N. (1964) · Journal of Bacteriology · doi:10.1128/jb.87.4.887-899.1964 · Cited by 159 · see citing works
Metronidazole Resistance in Clostridium difficile Is Heterogeneous
Peláez, T., Cercenado, E., Alcalá, L., Marín, M., Martín, A., Martínez-Alarcón, J., Catalán, P., Sánchez-Somolinos, M., & Bouza, E. (2008) · Journal of Clinical Microbiology · doi:10.1128/jcm.00524-08 · Cited by 156 · see citing works
Neoh, H., Cui, L., Yuzawa, H., Takeuchi, F., Matsuo, M., & Hiramatsu, K. (2007) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00534-07 · Cited by 156 · see citing works
Musta, A. C., RIEDERER, K. M., Shemes, S. P., Chase, P., Jose, J., Johnson, L. B., & Khatib, R. (2009) · Journal of Clinical Microbiology · doi:10.1128/jcm.02135-08 · Cited by 152 · see citing works
Epigenetic inheritance based evolution of antibiotic resistance in bacteria
Adam, M., Murali, B., Glenn, N. O., & Potter, S. S. (2008) · BMC Evolutionary Biology · doi:10.1186/1471-2148-8-52 · Cited by 149 · see citing works
Colistin heteroresistance in carbapenemase-producing Klebsiella pneumoniae
Meletis, G., Tzampaz, E., Sianou, E., et al. (2011) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkr007 · Cited by 148 · see citing works
An Outline of the Pattern of Bacterial Generation Times
Powell, E. O. (1958) · Journal of General Microbiology · doi:10.1099/00221287-18-2-382 · Cited by 148 · see citing works
Nongenetic Individuality in the Host–Phage Interaction
Mizrahi, S. P., Gabay, C., Kishony, R., Oppenheim, A. B., & Balaban, N. Q. (2008) · PLoS Biology · doi:10.1371/journal.pbio.0060120 · Cited by 144 · see citing works
Mechanisms of heteroresistance in methicillin-resistant Staphylococcus aureus
Ryffel, C., Strässle, A., Kayser, F. H., & Berger‐Bächi, B. (1994) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.38.4.724 · Cited by 140 · see citing works
Heteroresistance: a concern of increasing clinical significance?
Falagas, M. E., Makris, G. C., Dimopoulos, G., & Matthaiou, D. K. (2008) · Clinical Microbiology and Infection · doi:10.1111/j.1469-0691.2007.01912.x · Cited by 134 · see citing works
Hofmann-Thiel, S., van Ingen, J., Feldmann, K., Turaev, L., Uzakova, G., Murmusaeva, G., van Soolingen, D., & Hoffmann, H. (2008) · European Respiratory Journal · doi:10.1183/09031936.00089808 · Cited by 131 · see citing works
Schmerk, C. L., Bernards, M. A., & Valvano, M. A. (2011) · Journal of Bacteriology · doi:10.1128/jb.05979-11 · Cited by 125 · see citing works
Self-citationBae, I., Federspiel, J. J., Miró, J. M., Woods, C. W., Park, L., Rybak, M. J., Rude, T. H., Bradley, S., Bukovski, S., de la Maria, C. G., et al. (2009) · The Journal of Infectious Diseases · doi:10.1086/606027 · Cited by 122 · see citing works
Rodríguez, C. H., Bombicino, K. A., Granados, G., Nastro, M., Carlos, V., & Angela, F. (2009) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/j.diagmicrobio.2009.05.019 · Cited by 116 · see citing works
Nunes, A. P. F., TEIXEIRA, L., Iorio, N. L. P., et al. (2006) · International Journal of Antimicrobial Agents · doi:10.1016/j.ijantimicag.2005.11.013 · Cited by 113 · see citing works
van Merode, A. E. J., van der Mei, H. C., Busscher, H. J., et al. (2006) · Journal of Bacteriology · doi:10.1128/jb.188.7.2421-2426.2006 · Cited by 113 · see citing works
Marchese, A. E., Balistreri, G., Tonoli, E., Debbia, E. A., & Schito, G. C. (2000) · Journal of Clinical Microbiology · doi:10.1128/jcm.38.2.866-869.2000 · Cited by 112 · see citing works
Chambers, H. F. “., Hartman, B. J., & Tomasz, A. (1985) · Journal of Clinical Investigation · doi:10.1172/jci111965 · Cited by 110 · see citing works
Comparison of c-Nd:YVO4/YVO4 raman lasers and c-Nd:YVO4 self-Raman lasers
Wan, X. B., Wang, Q. P., Liu, Z., et al. (2011) · Laser Physics · doi:10.1134/s1054660x12010197 · Cited by 101 · see citing works
Matsuo, M., Hishinuma, T., Katayama, Y., Cui, L., Kapi, M., & Hiramatsu, K. (2011) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00398-11 · Cited by 100 · see citing works
Kelley, P., Gao, W., Ward, P. B., & Howden, B. P. (2011) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkr066 · Cited by 99 · see citing works
Folkvardsen, D. B., Thomsen, V. Ø., Rigouts, L., et al. (2013) · Journal of Clinical Microbiology · doi:10.1128/jcm.01602-13 · Cited by 98 · see citing works
Yusof, A., Engelhardt, A., Karlsson, A., Bylund, L., Vidh, P., Mills, K., Wootton, M., & Walsh, T. R. (2008) · Journal of Clinical Microbiology · doi:10.1128/jcm.00265-08 · Cited by 97 · see citing works
Chambers, H. F. “., & Hackbarth, C. J. (1987) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.31.12.1982 · Cited by 96 · see citing works
Haunreiter, V. D., Holmes, N., Kiefer, P., Christen, P., Patrignani, A., Vorholt, J. A., Berger‐Bächi, B., & Senn, M. M. (2013) · PLoS ONE · doi:10.1371/journal.pone.0073512 · Cited by 95 · see citing works
Antimicrobial susceptibility and heteroresistance in Chinese Clostridium difficile strains
Huang, H., Weintraub, A., Fang, H., et al. (2010) · Anaerobe · doi:10.1016/j.anaerobe.2010.09.002 · Cited by 95 · see citing works
El-Halfawy, O. M., & Valvano, M. A. (2013) · PLoS ONE · doi:10.1371/journal.pone.0068874 · Cited by 89 · see citing works
Self-citationLandman, D., Salamera, J., & Quale, J. M. (2013) · Journal of Clinical Microbiology · doi:10.1128/jcm.02129-13 · Cited by 89 · see citing works
van Hal, S. J., Wehrhahn, M. C., Barbagiannakos, T., Mercer, J. L., Chen, D., Paterson, D. L., & Gosbell, I. B. (2011) · Journal of Clinical Microbiology · doi:10.1128/jcm.02302-10 · Cited by 88 · see citing works
Frebourg, N. B., Nouet, D., Lemée, L., et al. (1998) · Journal of Clinical Microbiology · doi:10.1128/jcm.36.1.52-57.1998 · Cited by 85 · see citing works
Cafiso, V., Bertuccio, T., Spina, D., Purrello, S., Campanile, F., Pietro, C. D., Purrello, M., & Stefani, S. (2012) · PLoS ONE · doi:10.1371/journal.pone.0029573 · Cited by 84 · see citing works
Khatib, R., Jose, J., Musta, A. C., Sharma, M., Fakih, M. G., Johnson, L. B., RIEDERER, K. M., & Shemes, S. P. (2011) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkr169 · Cited by 81 · see citing works
van Hal, S. J., Jones, M., Gosbell, I. B., & Paterson, D. L. (2011) · PLoS ONE · doi:10.1371/journal.pone.0021217 · Cited by 79 · see citing works
Sieradzki, K., Roberts, R. B., Serur, D. S., Hargrave, J., & Tomasz, A. (1999) · Journal of Clinical Microbiology · doi:10.1128/jcm.37.1.39-44.1999 · Cited by 78 · see citing works
Pournaras, S., Kristo, I., Vrioni, G., et al. (2010) · Journal of Clinical Microbiology · doi:10.1128/jcm.02134-09 · Cited by 76 · see citing works
Maor, ., Rahav, G., Belausov, N., Ben-David, D., Smollan, G., & Keller, N. (2007) · Journal of Clinical Microbiology · doi:10.1128/jcm.01262-06 · Cited by 75 · see citing works
Selection of Heterogeneous Vancomycin-Intermediate Staphylococcus aureus by Imipenem
Katayama, Y., Murakami-Kuroda, H., Cui, L., et al. (2009) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00834-08 · Cited by 68 · see citing works
Kondo, N., Kuwahara‐Arai, K., Murakami-Kuroda, H., Tateda-Suzuki, E., & Hiramatsu, K. (2001) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.45.3.815-824.2001 · Cited by 68 · see citing works
Matteo, M. J., Granados, G., Olmos, M. A., et al. (2008) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkm504 · Cited by 68 · see citing works
Tato, M., Morosini, M. I., García, L. M., et al. (2010) · Journal of Clinical Microbiology · doi:10.1128/jcm.01130-10 · Cited by 66 · see citing works
Khosrovaneh, A., RIEDERER, K. M., Saeed, S., Tabriz, M. S., Shah, A. R., Hanna, M., Sharma, M., Johnson, L. B., Fakih, M. G., & Khatib, R. (2004) · Clinical Infectious Diseases · doi:10.1086/383036 · Cited by 65 · see citing works
Chesneau, O., Morvan, A., & Solh, N. E. (2000) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/45.6.887 · Cited by 65 · see citing works
Eilertson, B., Maruri, F., Blackman, A., Herrera, M., Samuels, D. C., & Sterling, T. R. (2014) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.02066-13 · Cited by 64 · see citing works
Bobin-Dubreux, S., Reverdy, M. E., Nervi, C., Rougier, M., Bolmström, A., Vandenesch, F., & Étienne, J. (2001) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.45.1.349-352.2001 · Cited by 62 · see citing works
Heteroresistance to penicillin in Streptococcus pneumoniae
Morand, B., & Mühlemann, K. (2007) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0702377104 · Cited by 61 · see citing works
A Microdilution Plating Method for Population Analysis of Antibiotic-Resistant Staphylococci
Pfeltz, R. F., Schmidt, J. L., & Wilkinson, B. J. (2001) · Microbial Drug Resistance · doi:10.1089/10766290152652846 · Cited by 61 · see citing works
Sader, H. S., Jones, R. N., Rossi, K., et al. (2009) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkp319 · Cited by 61 · see citing works
Wang, X., Kang, Y., Luo, C., Zhao, T., Liu, L., Jiang, X., Fu, R., An, S., Chen, J., Jiang, N., et al. (2014) · mBio · doi:10.1128/mbio.00942-13 · Cited by 60 · see citing works
Sun, W., Chen, H., Liu, Y., et al. (2009) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00206-09 · Cited by 60 · see citing works
Wu, S., de LENCASTRE, H., Šali, A., et al. (1996) · Microbial Drug Resistance · doi:10.1089/mdr.1996.2.277 · Cited by 59 · see citing works
El-Halfawy, O. M., & Valvano, M. A. (2014) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.02649-14 · Cited by 58 · see citing works
Self-citationRIEDERER, K. M., Shemes, S. P., Chase, P., Musta, A. C., mar, A. É., & Khatib, R. (2011) · Journal of Clinical Microbiology · doi:10.1128/jcm.01435-10 · Cited by 57 · see citing works
Heteroresistance to carbapenems in Acinetobacter baumannii
Pournaras, S., Ikonomidis, A., Markogiannakis, A., et al. (2005) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dki115 · Cited by 57 · see citing works
Hermes, D. M., Pitt, C. P., Lutz, L., Teixeira, A. B., Ribeiro, V. B., Netto, B., Martins, A. F., Zavascki, A. P., & Barth, A. L. (2013) · Journal of Medical Microbiology · doi:10.1099/jmm.0.059220-0 · Cited by 57 · see citing works
Weel, J. F. L., van der Hulst, R. W., Gerrits, Y., et al. (1996) · Journal of Clinical Microbiology · doi:10.1128/jcm.34.9.2158-2162.1996 · Cited by 57 · see citing works
Park, K.-H., Kim, E. S., Kim, H.-S., Park, S. J., Bang, K. M., Park, H. J., Park, S.-Y., Moon, S. M., Chong, Y. P., Kim, S., et al. (2012) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dks131 · Cited by 56 · see citing works
Lee, H.-Y., Chen, C., Wang, S.-B., et al. (2011) · International Journal of Antimicrobial Agents · doi:10.1016/j.ijantimicag.2010.12.015 · Cited by 56 · see citing works
Richter, S. S., Satola, S. W., Crispell, E. K., Heilmann, K. P., Dohrn, C. L., Riahi, F., Costello, A. J., Diekema, D. J., & Doern, G. V. (2011) · Journal of Clinical Microbiology · doi:10.1128/jcm.01152-11 · Cited by 55 · see citing works
de LENCASTRE, H., Figueiredo, A. M. S., & Tomasz, A. (1993) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/bf02389872 · Cited by 54 · see citing works
Heteroresistance of Helicobacter pylori from the same patient prior to antibiotic treatment
Kao, C., Lee, A.-Y., Huang, A.-H., Song, P.-Y., Yang, Y., Sheu, S., Chang, W.-L., Sheu, B., & Wu, J.-J. (2014) · Infection Genetics and Evolution · doi:10.1016/j.meegid.2014.02.009 · Cited by 53 · see citing works
Plipat, N., Livni, G., Bertram, H. C., & Thomson, R. B. (2005) · Journal of Clinical Microbiology · doi:10.1128/jcm.43.5.2494-2496.2005 · Cited by 52 · see citing works
Impact ofsarandagron methicillin resistance inStaphylococcus aureus
Durán, S. P., Kayser, F. H., & Berger‐Bächi, B. (1996) · FEMS Microbiology Letters · doi:10.1111/j.1574-6968.1996.tb08394.x · Cited by 52 · see citing works
Antimicrobial Resistance in Coagulase-Negative Staphylococci
Hamilton-Miller, J. M. T., & Iliffe, A. (1985) · Journal of Medical Microbiology · doi:10.1099/00222615-19-2-217 · Cited by 52 · see citing works
MODE OF ACTION OF STREPTOMYCIN ON TYPE b HEMOPHILUS INFLUENZAE
Alexander, H. E., & Leidy, G. (1947) · Journal of Experimental Medicine · doi:10.1084/jem.85.6.607 · Cited by 51 · see citing works
Pournaras, S., Ikonomidis, A., Markogiannakis, A., Spanakis, N., Maniatis, A. N., & Tsakris, A. (2006) · Journal of Medical Microbiology · doi:10.1099/jmm.0.46816-0 · Cited by 51 · see citing works
Adam, H. J., Louie, L., Watt, C., et al. (2009) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01316-09 · Cited by 51 · see citing works
Tsuji, B. T., & Rybak, M. J. (2005) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/j.diagmicrobio.2005.08.014 · Cited by 49 · see citing works
Glutamine Synthetase and Heteroresistance in Methicillin-Resistant Staphylococcus aureus
Stranden, A., Roos, M. A., & Berger‐Bächi, B. (1996) · Microbial Drug Resistance · doi:10.1089/mdr.1996.2.201 · Cited by 48 · see citing works
Campanile, F., Bongiorno, D., Falcone, M., Vailati, F., Pasticci, M. B., Perez, M. P., Raglio, A., Rumpianesi, F., Scuderi, C., Suter, F., et al. (2011) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-011-1367-y · Cited by 48 · see citing works
Goytia, M., & Shafer, W. M. (2010) · Infection and Immunity · doi:10.1128/iai.01301-09 · Cited by 48 · see citing works
Jahn, G., Laufs, R., Kaulfers, P.-M., et al. (1979) · Journal of Bacteriology · doi:10.1128/jb.138.2.584-597.1979 · Cited by 47 · see citing works
Expression and detection of hetero-vancomycin resistance in Staphylococcus aureus
Howe, R. A., Wootton, M., Walsh, T. R., Bennett, P. M., & MacGowan, A. P. (1999) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/44.5.675 · Cited by 46 · see citing works
Cuirolo, A., Plata, K. B., & Rosato, A. E. (2009) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkp164 · Cited by 45 · see citing works
Vancomycin Heteroresistance in Bloodstream Isolates of Staphylococcus capitis
D'mello, D., Daley, A. J., Rahman, M. S., et al. (2008) · Journal of Clinical Microbiology · doi:10.1128/jcm.00592-08 · Cited by 45 · see citing works
Bordetella pertussis Isolates with a Heterogeneous Phenotype for Erythromycin Resistance
Wilson, K. E., Cassiday, P. K., Popovic, T., et al. (2002) · Journal of Clinical Microbiology · doi:10.1128/jcm.40.8.2942-2944.2002 · Cited by 43 · see citing works
Bert, F., Clarissou, J., Durand, F., Delefosse, D., Chauvet, C., Lefebvre, P., Lambert, N., & Branger, C. (2003) · Journal of Clinical Microbiology · doi:10.1128/jcm.41.11.5147-5152.2003 · Cited by 42 · see citing works
Pitz, A. M., Yu, F., Hermsen, E. D., Rupp, M. E., Fey, P. D., & Olsen, K. M. (2010) · Journal of Clinical Microbiology · doi:10.1128/jcm.00914-10 · Cited by 42 · see citing works
Heteroresistance to Cephalosporins and Penicillins in Acinetobacter baumannii
Hung, K., Wang, M.-C., Huang, A.-H., et al. (2011) · Journal of Clinical Microbiology · doi:10.1128/jcm.05085-11 · Cited by 41 · see citing works
Heteroresistance to Vancomycin in Enterococcus faecium
Alam, M. R., Donabedian, S. M., Brown, W. J., et al. (2001) · Journal of Clinical Microbiology · doi:10.1128/jcm.39.9.3379-3381.2001 · Cited by 40 · see citing works
Engel, H., Gutiérrez‐Fernández, J., Flückiger, C., et al. (2013) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00223-13 · Cited by 39 · see citing works
Campanile, F., Borbone, S., Perez, M., Bongiorno, D., Cafiso, V., Bertuccio, T., Purrello, S., Nicolosi, D., Scuderi, C., & Stefani, S. (2010) · International Journal of Antimicrobial Agents · doi:10.1016/j.ijantimicag.2010.06.044 · Cited by 39 · see citing works
Ikonomidis, A., Tsakris, A., Καντζάνου, Μ., et al. (2008) · FEMS Microbiology Letters · doi:10.1111/j.1574-6968.2007.00997.x · Cited by 38 · see citing works
Heteroresistance to Meropenem in Carbapenem-Susceptible Acinetobacter baumannii
Ikonomidis, A., Neou, E., Gogou, V. A., et al. (2009) · Journal of Clinical Microbiology · doi:10.1128/jcm.00959-09 · Cited by 38 · see citing works
Cerquetti, M., Giufrè, M., Cardines, R., et al. (2007) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00335-07 · Cited by 37 · see citing works
Lin, S., Chen, T., Chen, F.-J., et al. (2012) · Journal of Microbiology Immunology and Infection · doi:10.1016/j.jmii.2012.05.004 · Cited by 37 · see citing works
Cafiso, V., Bertuccio, T., Spina, D., Campanile, F., Bongiorno, D., Santagati, M., Sciacca, A., Sciuto, C., & Stefani, S. (2010) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-010-1000-5 · Cited by 36 · see citing works
Park, I. J., Lee, W. G., Shin, J. H., et al. (2008) · Journal of Clinical Microbiology · doi:10.1128/jcm.00712-08 · Cited by 36 · see citing works
Yamakawa, J., Kurosawa, H., Kaneko, K., Yamakawa, J., AMINAKA, M., Hori, S., Cui, L., Ito, T., Jin, J., Hiramatsu, K., et al. (2011) · Journal of Infection and Chemotherapy · doi:10.1007/s10156-011-0330-2 · Cited by 35 · see citing works
Nunes, A. P. F., Schuenck, R. P., Bastos, C. C. R., et al. (2007) · The Brazilian Journal of Infectious Diseases · doi:10.1590/s1413-86702007000300009 · Cited by 35 · see citing works
Angelakis, E., Biswas, S., Taylor, C. T., et al. (2008) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkn094 · Cited by 35 · see citing works
Vancomycin heteroresistance and biofilm formation in Staphylococcus epidermidis from food
Gazzola, S., & Cocconcelli, P. S. (2008) · Microbiology · doi:10.1099/mic.0.2008/021154-0 · Cited by 35 · see citing works
Voß, A., Mouton, J. W., van Elzakker, E. P., Hendrix, R., Goessens, W. H. F., Kluytmans, J. A. J. W., Krabbe, P. F. M., de Neeling, A. J., Sloos, J. H., Öztoprak, N., et al. (2007) · Annals of Clinical Microbiology and Antimicrobials · doi:10.1186/1476-0711-6-9 · Cited by 34 · see citing works
Plata, K. B., Riosa, S., Singh, C. R., Rosato, R. R., & Rosato, A. E. (2013) · PLoS ONE · doi:10.1371/journal.pone.0061083 · Cited by 33 · see citing works
Yoshida, R. (2003) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkg036 · Cited by 32 · see citing works
Harigaya, Y., Ngo, D., Lesse, A. J., et al. (2011) · BMC Infectious Diseases · doi:10.1186/1471-2334-11-287 · Cited by 32 · see citing works
DeJonge, B. L. M., Chang, Y. S., Xu, N., et al. (1996) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.40.6.1498 · Cited by 31 · see citing works
Hegde, S. S., Skinner, R., Lewis, S. R., et al. (2010) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkq028 · Cited by 31 · see citing works
Engel, H., Mika, M., Denapaite, D., Hakenbeck, R., Mühlemann, K., Heller, M., Hathaway, L. J., & Hilty, M. (2014) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.02547-14 · Cited by 30 · see citing works
Ceftaroline-Heteroresistant Staphylococcus aureus
Saravolatz, S. N., Martin, H., Pawlak, J., et al. (2014) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.02685-13 · Cited by 27 · see citing works
Sancak, B., Yağcı, S., Gür, D., Gülay, Z., Öğünç, D., Söyletir, G., Yalçın, A. N., Dündar, D., Topçu, A. W., Akşit, F., et al. (2013) · BMC Infectious Diseases · doi:10.1186/1471-2334-13-583 · Cited by 26 · see citing works
Gustafson, J. E., & Wilkinson, B. J. (1989) · FEMS Microbiology Letters · doi:10.1111/j.1574-6968.1989.tb03092.x · Cited by 26 · see citing works
Rose, W. E., Knier, R., & Hutson, P. R. (2010) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkq292 · Cited by 26 · see citing works
Kirby, A., Mohandas, K., Broughton, C. M., et al. (2009) · Journal of Medical Microbiology · doi:10.1099/jmm.0.006486-0 · Cited by 26 · see citing works
Acquired and Native Resistance of Staphylococcus aureus to Cephalexin and Other β-Lactam Antibiotics
Kayser, F. H., Benner, E. J., & Hoeprich, P. D. (1970) · Applied Microbiology · doi:10.1128/am.20.1.1-5.1970 · Cited by 25 · see citing works
Naki̇poğlu, Y., Derbentli, Ş., Çağatay, A., et al. (2005) · BMC Infectious Diseases · doi:10.1186/1471-2334-5-31 · Cited by 25 · see citing works
Editorial Response: Relapsing Infection Due to Enterobacter Species: Lessons of Heterogeneity
Medeiros, A. A. (1997) · Clinical Infectious Diseases · doi:10.1086/516918 · Cited by 24 · see citing works
Loutet, S. A., Lorenzo, F. D., Clarke, C., et al. (2011) · BMC Genomics · doi:10.1186/1471-2164-12-472 · Cited by 24 · see citing works
Sola, C., Lamberghini, R. O., Ciarlantini, M., Egea, A. L., González, P., Diaz, E. G., Huerta, V., Gonzalez, J., Corso, A. C., Vilaró, M., et al. (2011) · Annals of Clinical Microbiology and Antimicrobials · doi:10.1186/1476-0711-10-15 · Cited by 24 · see citing works
Saleh, N. M., Hesham, M. S., Amin, M. A., et al. (2020) · Antibiotics · doi:10.3390/antibiotics9040164 · Cited by 24 · see citing works
Fernández-Cuenca, F., Gómez-Sánchez, M. C., Rodríguez‐Baño, J., et al. (2012) · International Journal of Antimicrobial Agents · doi:10.1016/j.ijantimicag.2012.05.005 · Cited by 23 · see citing works
Khan, S. A., Sung, K., Layton, S. L., & Nawaz, M. S. (2007) · International Journal of Antimicrobial Agents · doi:10.1016/j.ijantimicag.2007.08.007 · Cited by 23 · see citing works
Liu, Y., Li, J., Du, J.-F., et al. (2011) · Science China Life Sciences · doi:10.1007/s11427-011-4230-6 · Cited by 22 · see citing works
Goldman, J. L., Harrison, C. J., Myers, A., Jackson, M. A., & Selvarangan, R. (2014) · The Pediatric Infectious Disease Journal · doi:10.1097/01.inf.0000436281.18687.0c · Cited by 22 · see citing works
Baqnero, F., Vicente, M. F., & Pérez-Díaz, J. C. (1985) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/15.2.151 · Cited by 22 · see citing works
Fusco, D. N., Alexander, E. L., Weisenberg, S. A., Mediavilla, J. R., Kreiswirth, B. N., Schuetz, A. N., Jenkins, S. G., & Rhee, K. Y. (2009) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/j.diagmicrobio.2009.05.017 · Cited by 21 · see citing works
Knobloch, J. K. ‐., Jäger, S., Huck, J., et al. (2005) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.49.3.1216-1219.2005 · Cited by 21 · see citing works
Rybak, M. J., Cha, R., Cheung, C. M., Meka, V. G., & Kaatz, G. W. (2005) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/j.diagmicrobio.2004.09.005 · Cited by 21 · see citing works
Identification of Cephalosporin-Resistant Staphylococcus aureus with the Disc Diffusion Method
Hallander, H. O., & Laurell, G. (1972) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.1.5.422 · Cited by 21 · see citing works
Chen, H., Liu, Y., Sun, W., et al. (2011) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/j.diagmicrobio.2011.06.010 · Cited by 21 · see citing works
Williams, C. A., Nelson, D. C., Farah, B. A., et al. (1988) · FEMS Microbiology Letters · doi:10.1111/j.1574-6968.1988.tb02920.x · Cited by 20 · see citing works
OTT, J. L., Turner, J. R., & Mahoney, D. F. (1979) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.15.1.14 · Cited by 19 · see citing works
Superti, S. V., Martins, D. D. S., Caierão, J., et al. (2009) · Revista do Instituto de Medicina Tropical de São Paulo · doi:10.1590/s0036-46652009000200010 · Cited by 18 · see citing works
Kishii, K., Ito, T., Watanabe, S., et al. (2008) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkn186 · Cited by 18 · see citing works
Heterogeneous expression of glycopeptide resistance in enterococci associated with transfer of vanB
Hayden, M. K., Picken, R. N., & Sahm, D. F. (1997) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.41.4.872 · Cited by 18 · see citing works
Jarzembowski, T., Wiśniewska, K., Jóźwik, A., et al. (2009) · Current Microbiology · doi:10.1007/s00284-009-9395-x · Cited by 16 · see citing works
O’Brien, F. G., Botterill, C. I., Endersby, T. S. G., et al. (1998) · Pathology · doi:10.1080/00313029800169486 · Cited by 16 · see citing works
Plata, K. B., Rosato, R. R., & Rosato, A. E. (2011) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01119-09 · Cited by 16 · see citing works
Gordon, N. C., & Wareham, D. W. (2009) · Journal of Clinical Microbiology · doi:10.1128/jcm.01033-09 · Cited by 15 · see citing works
Iyer, R., & Hittinahalli, V. (2008) · Indian Journal of Medical Microbiology · doi:10.4103/0255-0857.40537 · Cited by 11 · see citing works
Tassios, P. T., Vatopoulos, A. C., Xanthaki, A., et al. (1997) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/bf01709481 · Cited by 10 · see citing works
Zavascki, A. P., Falci, D. R., da Silva, R. C. F., et al. (2014) · Infection Control and Hospital Epidemiology · doi:10.1086/676442 · Cited by 10 · see citing works
Savini, V., Catavitello, C., Talia, M., et al. (2009) · Journal of Infection · doi:10.1016/j.jinf.2009.02.001 · Cited by 10 · see citing works
Challenges in the microbiological diagnosis and management of hVISA infections
Cheong, J. W. S., Harris, P. N. A., Oman, K. M., & Norton, R. E. (2011) · Pathology · doi:10.1097/pat.0b013e3283464ca3 · Cited by 9 · see citing works
Søgaard, P., & Gahrn‐Hansen, B. (1986) · Acta Pathologica Microbiologica Scandinavica Section B Microbiology · doi:10.1111/j.1699-0463.1986.tb03066.x · Cited by 8 · see citing works
Population Analysis of Susceptibility To Cefotaxime in Enterobacteriaceae
Søgaard, P. (1985) · Acta Pathologica Microbiologica Scandinavica Section B Microbiology · doi:10.1111/j.1699-0463.1985.tb02902.x · Cited by 8 · see citing works
Cell wall deficiency and its effect on methicillin heteroresistance in Staphylococcus aureus
Markova, N., Haydoushka, I., Michailova, L., et al. (2007) · International Journal of Antimicrobial Agents · doi:10.1016/j.ijantimicag.2007.09.015 · Cited by 7 · see citing works
Norazah, A., Law, N. L., Kamel, A. G. M., et al. (2012) · PubMed · Cited by 7 · see citing works
Fink, S. L., Martinello, R. A., Campbell, S. M., & Murray, T. S. (2011) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.05024-11 · Cited by 6 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Distinguishing between resistance, tolerance and persistence to antibiotic treatment
Brauner, A., Fridman, O., Gefen, O., & Balaban, N. Q. (2016) · Nature Reviews Microbiology · doi:10.1038/nrmicro.2016.34 · Cited by 1,612 · see citing works
Definitions and guidelines for research on antibiotic persistence
Balaban, N. Q., Helaine, S., Lewis, K., Ackermann, M., Aldridge, B., Andersson, D. I., Brynildsen, M. P., Bumann, D., Camilli, A., Collins, J. J., et al. (2019) · Nature Reviews Microbiology · doi:10.1038/s41579-019-0196-3 · Cited by 1,313 · see citing works
Dynamic ploidy changes drive fluconazole resistance in human cryptococcal meningitis
Stone, N. R. H., Rhodes, J., Fisher, M. C., Mfinanga, S., Kivuyo, S., Rugemalila, J., Segal, E. S., Needleman, L., Molloy, S. F., Kwon-Chung, J., et al. (2019) · Journal of Clinical Investigation · doi:10.1172/jci124516 · Cited by 167 · see citing works
Treatment of Invasive Candidiasis: A Narrative Review
Ben-Ami, R. (2018) · Journal of Fungi · doi:10.3390/jof4030097 · Cited by 111 · see citing works
Ben-Ami, R., Zimmerman, O., Finn, T., Amit, S., Novikov, A., Wertheimer, N., Lurie-Weinberger, M., & Berman, J. (2016) · mBio · doi:10.1128/mbio.00655-16 · Cited by 88 · see citing works
Azole Resistance in Candida glabrata
Whaley, S. G., & Rogers, P. D. (2016) · Current Infectious Disease Reports · doi:10.1007/s11908-016-0554-5 · Cited by 85 · see citing works
Rogers, T. R., Verweij, P. E., Castanheira, M., Dannaoui, E., White, P. L., Arendrup, M. C., Subcommittee on Antifungal Susceptibility Testing (AFST) of the ESCMID European Committee for Antimicrobial Susceptibility Testing (EUCAST), Arendrup, M. C., Arikan-Akdagli, S., Barchiesi, F., et al. (2022) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkac161 · Cited by 82 · see citing works
Tian, Y., Zhang, Q., Wen, L., & Chen, J. (2021) · Microbiology Spectrum · doi:10.1128/spectrum.00152-21 · Cited by 62 · see citing works
Zhai, B., Liao, C., Jaggavarapu, S., Tang, Y., Rolling, T., Ning, Y., Sun, T., Bergin, S. A., Gjonbalaj, M., Miranda, E., et al. (2024) · Nature Medicine · doi:10.1038/s41591-024-03183-4 · Cited by 62 · see citing works
Levinson, T., Dahan, A., Novikov, A., Paran, Y., Berman, J., & Ben‐Ami, R. (2021) · Mycoses · doi:10.1111/myc.13191 · Cited by 50 · see citing works
Dai, Y., Li, C., Yi, J., Qin, Q., Liu, B., & Qiao, L. (2020) · Analytical Chemistry · doi:10.1021/acs.analchem.0c00494 · Cited by 31 · see citing works
Wang, Y., Ma, X., Zhao, L., He, Y., Yu, W., Fu, S., Ni, W., & Gao, Z. (2022) · Frontiers in Microbiology · doi:10.3389/fmicb.2022.868991 · Cited by 27 · see citing works
Gautier, C., Maciel, E. I., & Ene, I. V. (2024) · Microbiology Spectrum · doi:10.1128/spectrum.04041-23 · Cited by 23 · see citing works
Moreira, I. D. M. B., Cortez, A. C. A., de Souza, É. S., Pinheiro, S. B., de Souza Oliveira, J. G., Sadahiro, A., Cruz, K. S., Matsuura, A. B. J., Melhem, M. D. S. C., Frickmann, H., et al. (2022) · Medical Mycology · doi:10.1093/mmy/myac005 · Cited by 22 · see citing works
Xiong, Y., Han, Y., Zhao, Z., Gao, W., Ma, Y., Jiang, S., Wang, M., Zhang, Q., Zhou, Y., & Chen, Y. (2021) · Infection and Drug Resistance · doi:10.2147/idr.s340652 · Cited by 22 · see citing works
Zhang, F., Ding, M., Yan, X., Bai, J., Li, Q., Zhang, B., Liang, Q., Liang, S., Wang, G., & Zhou, Y. (2021) · Microbial Pathogenesis · doi:10.1016/j.micpath.2021.105162 · Cited by 17 · see citing works
Insight into the Mechanisms and Clinical Relevance of Antifungal Heteroresistance
Su, Y., Li, Y., Yi, Q., Xu, Y., Sun, T., & Li, Y. (2025) · Journal of Fungi · doi:10.3390/jof11020143 · Cited by 18 · see citing works
“For heteroresistance, the population analysis profile (PAP) assay is recommended as the gold standard [169].”
Huang, Y., Zhang, Y., Yang, S., Lu, H., Yu, H., Wang, X., Jia, X., Tang, D., Wu, L., Huang, S., et al. (2024) · Microbiology Spectrum · doi:10.1128/spectrum.00725-24 · Cited by 12 · see citing works
Nurjadi, D., Chanthalangsy, Q., Zizmann, E., Stuermer, V., Moll, M., Klein, S., Boutin, S., Heeg, K., & Zanger, P. (2021) · Microbiology Spectrum · doi:10.1128/spectrum.01510-21 · Cited by 10 · see citing works
- Authors
- El-Halfawy, O. M., & Valvano, M. A.
- Affiliations
- Western University (CA)
- Corresponding author
- Valvano, Miguel A.
- Venue
- Clinical Microbiology Reviews
- Publisher
- American Society for Microbiology
- Published
- 2015-01
- Volume
- 28
- Issue
- 1
- Pages
- 191-207
- ISSN
- 0893-8512 (ISSN-L)
- 1098-6618
- PMC
- PMC4284305
- 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
- bronze
- doi.org
- 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
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.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review