title: Clinical implications of vancomycin heteroresistant and intermediately susceptible Staphylococcus aureus.
abstract: Staphylococcus aureus (S. aureus) has proven to be a major pathogen with the emergence of methicillin-resistant S. aureus (MRSA) infections and recently with heteroresistant vancomycin-intermediate S. aureus (hVISA) and vancomycin-intermediate S. aureus (VISA) infections. Although vancomycin is traditionally a first-line and relatively effective antibiotic, its continued use is under question because reports of heteroresistance in S. aureus isolates are increasing. Both hVISA and VISA infections are associated with complicated clinical courses and treatment failures. The prevalence, mechanism of resistance, clinical significance, and laboratory detection of hVISA and VISA infections are not conclusive, making it difficult to apply research findings to clinical situations. We provide an evidence-based review of S. aureus isolates expressing heterogenic and reduced susceptibility to vancomycin.
authors.affiliation: Department of Pharmacy Practice, University of Rhode Island, Kingston, Rhode Island; Veterans Affairs Medical Center, Providence, Rhode Island.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Gomes
authors.forename: Kristina E
authors.initials: KE
authors.lastname: Ward
authors.forename: Kerry L
authors.initials: KL
authors.lastname: LaPlante
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use; D017576:Daptomycin / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D006801:Humans; D000069349:Linezolid / Q000494:pharmacology / Q000627:therapeutic use; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects*; D014640:Vancomycin / Q000494:pharmacology* / Q000627:therapeutic use; D000097583:Ceftaroline
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D017576:Daptomycin; D000069349:Linezolid; D014640:Vancomycin; D000097583:Ceftaroline
keywords: Heterogeneous vancomycin-intermediate Staphylococcus aureus; Staphylococcus aureus; intermediate; methicillin-resistant Staphylococcus aureus; minimum inhibitory concentration; reduced susceptibility; resistance; screening; vancomycin; vancomycin-intermediate Staphylococcus aureus