{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T20:39:42Z","timestamp":1788813582893,"version":"build-2803163510"},"reference-count":108,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Mol Biol Rep"],"published-print":{"date-parts":[[2026,12]]},"DOI":"10.1007\/s11033-026-12280-1","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T08:39:42Z","timestamp":1783067982000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond susceptibility results: understanding the clinical and diagnostic burden of bacterial heteroresistance"],"prefix":"10.1007","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0652-5847","authenticated-orcid":false,"given":"Esra","family":"Ta\u015f","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8147-1028","authenticated-orcid":false,"given":"Feride Mehtap","family":"Y\u00fccel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"issue":"6","key":"12280_CR1","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1084\/jem.85.6.607","volume":"85","author":"HE Alexander","year":"1947","unstructured":"Alexander HE, Leidy G (1947) Mode of action of streptomycin on type b Haemophilus influenzae. II. Nature of resistant variants. J Exp Med 85(6):607\u2013621","journal-title":"J Exp Med"},{"issue":"4","key":"12280_CR2","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1128\/jb.87.4.887-899.1964","volume":"87","author":"R Sutherland","year":"1964","unstructured":"Sutherland R, Rolinson GN (1964) Characteristics of methicillin-resistant staphylococci. J Bacteriol 87(4):887\u2013899","journal-title":"J Bacteriol"},{"issue":"1","key":"12280_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1128\/am.20.1.1-5.1970","volume":"20","author":"FH Kayser","year":"1970","unstructured":"Kayser FH, Benner EJ, Hoeprich PD (1970) Acquired and native resistance of Staphylococcus aureus to cephalexin and other beta-lactam antibiotics. Appl Microbiol 20(1):1\u20135","journal-title":"Appl Microbiol"},{"issue":"1","key":"12280_CR4","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1128\/CMR.00058-14","volume":"28","author":"OM El-Halfawy","year":"2015","unstructured":"El-Halfawy OM, Valvano MA (2015) Antimicrobial heteroresistance: An emerging field in need of clarity. Clin Microbiol Rev 28(1):191\u2013207. https:\/\/doi.org\/10.1128\/CMR.00058-14","journal-title":"Clin Microbiol Rev"},{"key":"12280_CR5","doi-asserted-by":"publisher","unstructured":"Carvalho G, Forestier C, Mathias J-D (2019) Antibiotic resilience: A necessary concept to complement antibiotic resistance? Proceedings of the Royal Society B: Biological Sciences, 286(1916), 20192408. https:\/\/doi.org\/10.1098\/rspb.2019.2408","DOI":"10.1098\/rspb.2019.2408"},{"key":"12280_CR6","doi-asserted-by":"publisher","first-page":"3641","DOI":"10.1038\/s41467-026-70174-z","volume":"17","author":"M Ma","year":"2026","unstructured":"Ma M, Kim M (2026) High-resolution, high-throughput detection of hidden antibiotic resistance with the dilution-and-delay (DnD) susceptibility assay. Nat Commun 17:3641. https:\/\/doi.org\/10.1038\/s41467-026-70174-z","journal-title":"Nat Commun"},{"issue":"3","key":"12280_CR7","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1093\/jac\/dkm504","volume":"61","author":"MJ Matteo","year":"2008","unstructured":"Matteo MJ, Granados G, Olmos M, Wonaga A, Catalano M (2008) Helicobacter pylori amoxicillin heteroresistance due to point mutations in PBP-1A in isogenic isolates. J Antimicrob Chemother 61(3):474\u2013477. https:\/\/doi.org\/10.1093\/jac\/dkm504","journal-title":"J Antimicrob Chemother"},{"issue":"12","key":"12280_CR8","doi-asserted-by":"publisher","first-page":"4220","DOI":"10.1128\/JCM.01602-13","volume":"51","author":"DB Folkvardsen","year":"2013","unstructured":"Folkvardsen DB, Thomsen V\u00d8, Rigouts L, Rasmussen EM, Bang D, Bernaerts G, Werngren J, Toro JC, Hoffner S, Hillemann D, Svensson E (2013) Rifampin heteroresistance in Mycobacterium tuberculosis cultures as detected by phenotypic and genotypic drug susceptibility test methods. J Clin Microbiol 51(12):4220\u20134222. https:\/\/doi.org\/10.1128\/JCM.01602-13","journal-title":"J Clin Microbiol"},{"issue":"8","key":"12280_CR9","doi-asserted-by":"publisher","first-page":"4636","DOI":"10.1128\/AAC.02820-13","volume":"58","author":"AM Casapao","year":"2014","unstructured":"Casapao AM, Davis SL, McRoberts JP, Lagnf AM, Patel S, Kullar R, Levine DP, Rybak MJ (2014) Evaluation of vancomycin population susceptibility analysis profile as a predictor of outcomes for patients with infective endocarditis due to methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 58(8):4636\u20134641. https:\/\/doi.org\/10.1128\/AAC.02820-13","journal-title":"Antimicrob Agents Chemother"},{"issue":"11","key":"12280_CR10","doi-asserted-by":"publisher","first-page":"2187","DOI":"10.1007\/s10096-017-3044-2","volume":"36","author":"CK Kang","year":"2017","unstructured":"Kang CK, Kim YK, Jung SI, Park WB, Song KH, Park KH, Choe PG, Jang HC, Lee S, Kim YS, Kwak YG, Kwon KT, Kiem S, Kim CJ, Kim ES, Kim HB, Korea INfectious Diseases (KIND) study group (2017) agr functionality affects clinical outcomes in patients with persistent methicillin-resistant Staphylococcus aureus bacteraemia. Eur J Clin Microbiol Infect diseases: official publication Eur Soc Clin Microbiol 36(11):2187\u20132191. https:\/\/doi.org\/10.1007\/s10096-017-3044-2","journal-title":"Eur J Clin Microbiol Infect diseases: official publication Eur Soc Clin Microbiol"},{"key":"12280_CR11","doi-asserted-by":"publisher","first-page":"117430","DOI":"10.1016\/j.watres.2021.117430","volume":"202","author":"Z Wang","year":"2021","unstructured":"Wang Z, Chen Q, Zhang J, Yan H, Chen Y, Chen C, Chen X (2021) High prevalence of unstable antibiotic heteroresistance in cyanobacteria causes resistance underestimation. Water Res 202:117430. https:\/\/doi.org\/10.1016\/j.watres.2021.117430","journal-title":"Water Res"},{"issue":"2","key":"12280_CR12","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/j.molcel.2019.09.028","volume":"76","author":"L Dewachter","year":"2019","unstructured":"Dewachter L, Fauvart M, Michiels J (2019) Bacterial Heterogeneity and Antibiotic Survival: Understanding and Combatting Persistence and Heteroresistance. Mol Cell 76(2):255\u2013267. https:\/\/doi.org\/10.1016\/j.molcel.2019.09.028","journal-title":"Mol Cell"},{"issue":"8","key":"12280_CR13","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1038\/s41579-019-0218-1","volume":"17","author":"DI Andersson","year":"2019","unstructured":"Andersson DI, Nicoloff H, Hjort K (2019) Mechanisms and clinical relevance of bacterial heteroresistance. Nature reviews Microbiol 17(8):479\u2013496. https:\/\/doi.org\/10.1038\/s41579-019-0218-1","journal-title":"Nature reviews Microbiol"},{"issue":"1","key":"12280_CR14","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1128\/CMR.00042-09","volume":"23","author":"BP Howden","year":"2010","unstructured":"Howden BP, Davies JK, Johnson PD, Stinear TP, Grayson ML (2010) Reduced vancomycin susceptibility in Staphylococcus aureus, including vancomycin-intermediate and heterogeneous vancomycin-intermediate strains: resistance mechanisms, laboratory detection, and clinical implications. Clin Microbiol Rev 23(1):99\u2013139. https:\/\/doi.org\/10.1128\/CMR.00042-09","journal-title":"Clin Microbiol Rev"},{"issue":"6","key":"12280_CR15","doi-asserted-by":"publisher","first-page":"e1007726","DOI":"10.1371\/journal.ppat.1007726","volume":"15","author":"VI Band","year":"2019","unstructured":"Band VI, Weiss DS (2019) Heteroresistance: A cause of unexplained antibiotic treatment failure? PLoS Pathog 15(6):e1007726. https:\/\/doi.org\/10.1371\/journal.ppat.1007726","journal-title":"PLoS Pathog"},{"issue":"20","key":"12280_CR16","doi-asserted-by":"publisher","first-page":"13929","DOI":"10.1074\/jbc.R113.472274","volume":"288","author":"J Casades\u00fas","year":"2013","unstructured":"Casades\u00fas J, Low DA (2013) Programmed heterogeneity: epigenetic mechanisms in bacteria. J Biol Chem 288(20):13929\u201313935. https:\/\/doi.org\/10.1074\/jbc.R113.472274","journal-title":"J Biol Chem"},{"key":"12280_CR17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.plasmid.2014.06.004","volume":"75","author":"CJ Dorman","year":"2014","unstructured":"Dorman CJ (2014) H-NS-like nucleoid-associated proteins, mobile genetic elements and horizontal gene transfer in bacteria. Plasmid 75:1\u201311. https:\/\/doi.org\/10.1016\/j.plasmid.2014.06.004","journal-title":"Plasmid"},{"issue":"4","key":"12280_CR18","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1534\/genetics.109.111963","volume":"184","author":"AB Reams","year":"2010","unstructured":"Reams AB, Kofoid E, Savageau M, Roth JR (2010) Duplication frequency in a population of Salmonella enterica rapidly approaches steady state with or without recombination. Genetics 184(4):1077\u20131094. https:\/\/doi.org\/10.1534\/genetics.109.111963","journal-title":"Genetics"},{"issue":"10","key":"12280_CR19","doi-asserted-by":"publisher","first-page":"1812","DOI":"10.1093\/cid\/ciz364","volume":"69","author":"VJ Waters","year":"2019","unstructured":"Waters VJ, Kidd TJ, Canton R, Ekkelenkamp MB, Johansen HK, LiPuma JJ, Bell SC, Elborn JS, Flume PA, VanDevanter DR, Gilligan P, Antimicrobial Resistance International Working Group in Cystic Fibrosis (2019) Reconciling Antimicrobial Susceptibility Testing and Clinical Response in Antimicrobial Treatment of Chronic Cystic Fibrosis Lung Infections. Clin Infect diseases: official publication Infect Dis Soc Am 69(10):1812\u20131816. https:\/\/doi.org\/10.1093\/cid\/ciz364","journal-title":"Clin Infect diseases: official publication Infect Dis Soc Am"},{"issue":"12","key":"12280_CR20","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1007\/s00203-024-04173-3","volume":"206","author":"S Pani","year":"2024","unstructured":"Pani S, Mohapatra SS (2024) Phenotypic heterogeneity in bacteria: The rise of antibiotic persistence, clinical implications, and therapeutic opportunities. Arch Microbiol 206(12):446. https:\/\/doi.org\/10.1007\/s00203-024-04173-3","journal-title":"Arch Microbiol"},{"key":"12280_CR21","doi-asserted-by":"publisher","first-page":"803","DOI":"10.3389\/fmicb.2017.00803","volume":"8","author":"P Dersch","year":"2017","unstructured":"Dersch P, Khan MA, M\u00fchlen S, G\u00f6rke B (2017) Roles of regulatory RNAs for antibiotic resistance in bacteria and their potential value as novel drug targets. Front Microbiol 8:803. https:\/\/doi.org\/10.3389\/fmicb.2017.00803","journal-title":"Front Microbiol"},{"issue":"3","key":"12280_CR22","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1038\/s41564-018-0342-0","volume":"4","author":"H Nicoloff","year":"2019","unstructured":"Nicoloff H, Hjort K, Levin BR, Andersson DI (2019) The high prevalence of antibiotic heteroresistance in pathogenic bacteria is mainly caused by gene amplification. Nat Microbiol 4(3):504\u2013514. https:\/\/doi.org\/10.1038\/s41564-018-0342-0","journal-title":"Nat Microbiol"},{"issue":"1","key":"12280_CR23","doi-asserted-by":"publisher","first-page":"2366354","DOI":"10.1080\/22221751.2024.2366354","volume":"13","author":"Z Zhao","year":"2024","unstructured":"Zhao Z, Yang T, Xiang G, Zhang S, Cai Y, Zhong G, Pu J, Shen C, Zeng J, Chen C, Huang B (2024) A novel small RNA PhaS contributes to polymyxin B-heteroresistance in carbapenem-resistant Klebsiella pneumoniae. Emerg microbes infections 13(1):2366354. https:\/\/doi.org\/10.1080\/22221751.2024.2366354","journal-title":"Emerg microbes infections"},{"issue":"6","key":"12280_CR24","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/j.chom.2017.10.020","volume":"22","author":"JH Yang","year":"2017","unstructured":"Yang JH, Bhargava P, McCloskey D, Mao N, Palsson BO, Collins JJ (2017) Antibiotic-Induced Changes to the Host Metabolic Environment Inhibit Drug Efficacy and Alter Immune Function. Cell Host Microbe 22(6):757\u2013765e3. https:\/\/doi.org\/10.1016\/j.chom.2017.10.020","journal-title":"Cell Host Microbe"},{"key":"12280_CR25","doi-asserted-by":"publisher","first-page":"8773","DOI":"10.1038\/ncomms9773","volume":"6","author":"RA Sorg","year":"2015","unstructured":"Sorg RA, Veening J-W (2015) Microscale insights into pneumococcal antibiotic mutant selection windows. Nat Commun 6:8773. https:\/\/doi.org\/10.1038\/ncomms9773","journal-title":"Nat Commun"},{"key":"12280_CR26","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1038\/ncomms1025","volume":"1","author":"RD Turner","year":"2010","unstructured":"Turner RD, Ratcliffe EC, Wheeler R, Golestanian R, Hobbs JK, Foster SJ (2010) Peptidoglycan architecture can specify division planes in Staphylococcus aureus. Nat Commun 1:26. https:\/\/doi.org\/10.1038\/ncomms1025","journal-title":"Nat Commun"},{"issue":"10","key":"12280_CR27","doi-asserted-by":"publisher","first-page":"4095","DOI":"10.1093\/molbev\/msab196","volume":"38","author":"R Guti\u00e9rrez","year":"2021","unstructured":"Guti\u00e9rrez R, Ram Y, Berman J, de Sousa KCM, Nachum-Biala Y, Britzi M, Elad D, Glaser G, Covo S, Harrus S (2021) Adaptive Resistance Mutations at Suprainhibitory Concentrations Independent of SOS Mutagenesis. Mol Biol Evol 38(10):4095\u20134115. https:\/\/doi.org\/10.1093\/molbev\/msab196","journal-title":"Mol Biol Evol"},{"issue":"7","key":"12280_CR28","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1038\/s41429-020-0289-2","volume":"73","author":"L Chen","year":"2020","unstructured":"Chen L, Lin J, Lu H, Zhang X, Wang C, Liu H, Zhang X, Li J, Cao J, Zhou T (2020) Deciphering colistin heteroresistance in Acinetobacter baumannii clinical isolates from Wenzhou, China. J Antibiot 73(7):463\u2013470. https:\/\/doi.org\/10.1038\/s41429-020-0289-2","journal-title":"J Antibiot"},{"key":"12280_CR29","doi-asserted-by":"publisher","first-page":"1332458","DOI":"10.3389\/fmicb.2024","volume":"15","author":"Y Zhang","year":"2024","unstructured":"Zhang Y, Liu D, Liu Y, Li Q, Liu H, Zhou P, Liu Y, Chen L, Yin W, Lu Y (2024) Detection and characterization of eravacycline heteroresistance in clinical bacterial isolates. Front Microbiol 15:1332458. https:\/\/doi.org\/10.3389\/fmicb.2024","journal-title":"Front Microbiol"},{"key":"12280_CR30","doi-asserted-by":"publisher","first-page":"37","DOI":"10.3389\/fcimb.2017.00037","volume":"7","author":"Y Chen","year":"2017","unstructured":"Chen Y, Hu D, Zhang Q, Liao XP, Liu YH, Sun J (2017) Efflux Pump Overexpression Contributes to Tigecycline Heteroresistance in Salmonella enterica serovar Typhimurium. Front Cell Infect Microbiol 7:37. https:\/\/doi.org\/10.3389\/fcimb.2017.00037","journal-title":"Front Cell Infect Microbiol"},{"issue":"6","key":"12280_CR31","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1099\/jmm.0.000741","volume":"67","author":"D Machado","year":"2018","unstructured":"Machado D, Antunes J, Sim\u00f5es A, Perdig\u00e3o J, Couto I, McCusker M, Martins M, Portugal I, Pacheco T, Batista J, Toscano C, Viveiros M (2018) Contribution of efflux to colistin heteroresistance in a multidrug resistant Acinetobacter baumannii clinical isolate. J Med Microbiol 67(6):740\u2013749. https:\/\/doi.org\/10.1099\/jmm.0.000741","journal-title":"J Med Microbiol"},{"issue":"2","key":"12280_CR32","doi-asserted-by":"publisher","first-page":"106065","DOI":"10.1016\/j.ijantimicag.2020.106065","volume":"56","author":"S Karakonstantis","year":"2020","unstructured":"Karakonstantis S, Saridakis I (2020) Colistin heteroresistance in Acinetobacter spp.: systematic review and meta-analysis of the prevalence and discussion of the mechanisms and potential therapeutic implications. Int J Antimicrob Agents 56(2):106065. https:\/\/doi.org\/10.1016\/j.ijantimicag.2020.106065","journal-title":"Int J Antimicrob Agents"},{"issue":"8","key":"12280_CR33","doi-asserted-by":"publisher","first-page":"fiz115","DOI":"10.1093\/femsec\/fiz115","volume":"95","author":"P Jorge","year":"2019","unstructured":"Jorge P, Magalh\u00e3es AP, Grainha T, Alves D, Sousa AM, Lopes SP, Pereira MO (2019) Antimicrobial resistance three ways: healthcare crisis, major concepts and the relevance of biofilms. FEMS Microbiol Ecol 95(8):fiz115. https:\/\/doi.org\/10.1093\/femsec\/fiz115","journal-title":"FEMS Microbiol Ecol"},{"issue":"12","key":"12280_CR34","doi-asserted-by":"publisher","first-page":"e0169924","DOI":"10.1128\/mbio.01699-24","volume":"15","author":"AJ Choi","year":"2024","unstructured":"Choi AJ, Bennison DJ, Kulkarni E, Azar H, Sun H, Li H, Bradshaw J, Yeap HW, Lim N, Mishra V, Crespo-Puig A, Mills EA, Davies F, Sriskandan S, Shenoy AR (2024) Aminoglycoside heteroresistance in Enterobacter cloacae is driven by the cell envelope stress response. mBio 15(12):e0169924. https:\/\/doi.org\/10.1128\/mbio.01699-24","journal-title":"mBio"},{"issue":"10","key":"12280_CR35","doi-asserted-by":"publisher","first-page":"3726","DOI":"10.1128\/AAC.01406-06","volume":"51","author":"JR Lo-Ten-Foe","year":"2007","unstructured":"Lo-Ten-Foe JR, de Smet AM, Diederen BM, Kluytmans JA, van Keulen PH (2007) Comparative evaluation of the VITEK 2, disk diffusion, etest, broth microdilution, and agar dilution susceptibility testing methods for colistin in clinical isolates, including heteroresistant Enterobacter cloacae and Acinetobacter baumannii strains. Antimicrob Agents Chemother 51(10):3726\u20133730. https:\/\/doi.org\/10.1128\/AAC.01406-06","journal-title":"Antimicrob Agents Chemother"},{"issue":"9","key":"12280_CR36","doi-asserted-by":"publisher","first-page":"2946","DOI":"10.1128\/AAC.00103-06","volume":"50","author":"J Li","year":"2006","unstructured":"Li J, Rayner CR, Nation RL, Owen RJ, Spelman D, Tan KE, Liolios L (2006) Heteroresistance to colistin in multidrug-resistant Acinetobacter baumannii. Antimicrob Agents Chemother 50(9):2946\u20132950. https:\/\/doi.org\/10.1128\/AAC.00103-06","journal-title":"Antimicrob Agents Chemother"},{"issue":"1","key":"12280_CR37","doi-asserted-by":"publisher","first-page":"449","DOI":"10.3390\/ijms23010449","volume":"23","author":"K Stojowska-Sw\u0119drzy\u0144ska","year":"2021","unstructured":"Stojowska-Sw\u0119drzy\u0144ska K, \u0141upkowska A, Kuczy\u0144ska-Wi\u015bnik D, Laskowska E (2021) Antibiotic Heteroresistance in Klebsiella pneumoniae. Int J Mol Sci 23(1):449. https:\/\/doi.org\/10.3390\/ijms23010449","journal-title":"Int J Mol Sci"},{"key":"12280_CR38","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1038\/s42003-024-06894-z","volume":"7","author":"J Hira","year":"2024","unstructured":"Hira J, Singh B, Halder T et al (2024) Single-cell phenotypic profiling and backtracing exposes and predicts clinically relevant subpopulations in isogenic Staphylococcus aureus communities. Commun Biology 7:1228. https:\/\/doi.org\/10.1038\/s42003-024-06894-z","journal-title":"Commun Biology"},{"issue":"3","key":"12280_CR39","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1016\/j.cmi.2022.10.018","volume":"29","author":"M Roch","year":"2023","unstructured":"Roch M, Sierra R, Andrey DO (2023) Antibiotic heteroresistance in ESKAPE pathogens, from bench to bedside. Clin Microbiol infection: official publication Eur Soc Clin Microbiol Infect Dis 29(3):320\u2013325. https:\/\/doi.org\/10.1016\/j.cmi.2022.10.018","journal-title":"Clin Microbiol infection: official publication Eur Soc Clin Microbiol Infect Dis"},{"issue":"9","key":"12280_CR40","doi-asserted-by":"publisher","first-page":"3042","DOI":"10.1128\/JCM.00265-08","volume":"46","author":"A Yusof","year":"2008","unstructured":"Yusof A, Engelhardt A, Karlsson A, Bylund L, Vidh P, Mills K, Wootton M, Walsh TR (2008) Evaluation of a new Etest vancomycin-teicoplanin strip for detection of glycopeptide-intermediate Staphylococcus aureus (GISA), in particular, heterogeneous GISA. J Clin Microbiol 46(9):3042\u20133047. https:\/\/doi.org\/10.1128\/JCM.00265-08","journal-title":"J Clin Microbiol"},{"issue":"4","key":"12280_CR41","doi-asserted-by":"publisher","first-page":"1489","DOI":"10.1128\/JCM.02302-10","volume":"49","author":"SJ van Hal","year":"2011","unstructured":"van Hal SJ, Wehrhahn MC, Barbagiannakos T, Mercer J, Chen D, Paterson DL, Gosbell IB (2011) Performance of various testing methodologies for detection of heteroresistant vancomycin-intermediate Staphylococcus aureus in bloodstream isolates. J Clin Microbiol 49(4):1489\u20131494. https:\/\/doi.org\/10.1128\/JCM.02302-10","journal-title":"J Clin Microbiol"},{"issue":"6","key":"12280_CR42","doi-asserted-by":"publisher","first-page":"2147","DOI":"10.1128\/JCM.01435-10","volume":"49","author":"K Riederer","year":"2011","unstructured":"Riederer K, Shemes S, Chase P, Musta A, Mar A, Khatib R (2011) Detection of intermediately vancomycin-susceptible and heterogeneous Staphylococcus aureus isolates: comparison of Etest and Agar screening methods. J Clin Microbiol 49(6):2147\u20132150. https:\/\/doi.org\/10.1128\/JCM.01435-10","journal-title":"J Clin Microbiol"},{"issue":"1","key":"12280_CR43","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1038\/s44259-025-00076-5","volume":"3","author":"L Xu","year":"2025","unstructured":"Xu L, Mo X, Zhang H, Wan F, Luo Q, Xiao Y (2025) Epidemiology, mechanisms, and clinical impact of bacterial heteroresistance. npj antimicrobials Resist 3(1):7. https:\/\/doi.org\/10.1038\/s44259-025-00076-5","journal-title":"npj antimicrobials Resist"},{"key":"12280_CR44","unstructured":"European Committee on Antimicrobial Susceptibility Testing (2024) Breakpoint tables for interpretation of MICs and zone diameters. https:\/\/www.eucast.org\/clinical_breakpoints"},{"key":"12280_CR45","unstructured":"Clinical and Laboratory Standards Institute (2023) Performance standards for antimicrobial susceptibility testing (33rd ed., CLSI supplement M100). CLSI"},{"issue":"4","key":"12280_CR46","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1093\/jac\/47.4.399","volume":"47","author":"M Wootton","year":"2001","unstructured":"Wootton M, Howe RA, Hillman R, Walsh TR, Bennett PM, MacGowan AP (2001) A modified population analysis profile (PAP) method to detect hetero-resistance to vancomycin in Staphylococcus aureus in a UK hospital. J Antimicrob Chemother 47(4):399\u2013403. https:\/\/doi.org\/10.1093\/jac\/47.4.399","journal-title":"J Antimicrob Chemother"},{"issue":"5","key":"12280_CR47","doi-asserted-by":"publisher","first-page":"e108661","DOI":"10.7759\/cureus.108661","volume":"18","author":"MB Jadhav","year":"2026","unstructured":"Jadhav MB, Karande G, Patil S (2026) Staphylococcus aureus With Reduced Vancomycin Susceptibility: Diagnostic Challenges in Clinical Settings. Cureus 18(5):e108661. https:\/\/doi.org\/10.7759\/cureus.108661","journal-title":"Cureus"},{"issue":"7","key":"12280_CR48","doi-asserted-by":"publisher","first-page":"e88122","DOI":"10.7759\/cureus.88122","volume":"17","author":"A Agarwal","year":"2025","unstructured":"Agarwal A, Singhal L, Kour I, Gupta P, Kaur N, Vasesi D, Gupta V (2025) Prevalence and Detection of Heteroresistant Vancomycin-Intermediate Staphylococcus aureus (hVISA) Among Clinical Isolates: A Comparative Evaluation of Screening Methods. Cureus 17(7):e88122. https:\/\/doi.org\/10.7759\/cureus.88122","journal-title":"Cureus"},{"issue":"2","key":"12280_CR49","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/j.idc.2016.02.005","volume":"30","author":"KS Kaye","year":"2016","unstructured":"Kaye KS, Pogue JM, Tran TB, Nation RL, Li J (2016) Agents of Last Resort: Polymyxin Resistance. Infect Dis Clin N Am 30(2):391\u2013414. https:\/\/doi.org\/10.1016\/j.idc.2016.02.005","journal-title":"Infect Dis Clin N Am"},{"key":"12280_CR50","doi-asserted-by":"publisher","first-page":"103887","DOI":"10.1016\/j.micpath.2019.103887","volume":"139","author":"A Pormohammad","year":"2020","unstructured":"Pormohammad A, Mehdinejadiani K, Gholizadeh P et al (2020) Global prevalence of colistin resistance in clinical isolates of Acinetobacter baumannii: A systematic review and meta-analysis. Microb Pathog 139:103887","journal-title":"Microb Pathog"},{"issue":"10","key":"12280_CR51","doi-asserted-by":"publisher","first-page":"1627","DOI":"10.1038\/s41564-019-0480-z","volume":"4","author":"VI Band","year":"2019","unstructured":"Band VI, Hufnagel DA, Jaggavarapu S, Sherman EX, Wozniak JE, Satola SW, Farley MM, Jacob JT, Burd EM, Weiss DS, Rather PN (2019) Antibiotic combinations that exploit heteroresistance to multiple drugs effectively control infection. Nat Microbiol 4(10):1627\u20131635. https:\/\/doi.org\/10.1038\/s41564-019-0480-z","journal-title":"Nat Microbiol"},{"key":"12280_CR52","first-page":"457","volume":"3","author":"Y Koyama","year":"1950","unstructured":"Koyama Y (1950) A new antibiotic colistin produced by spore-forming soil bacteria. J Antibiot 3:457\u2013458","journal-title":"J Antibiot"},{"issue":"9","key":"12280_CR53","doi-asserted-by":"publisher","first-page":"1333","DOI":"10.1086\/429323","volume":"40","author":"ME Falagas","year":"2005","unstructured":"Falagas ME, Kasiakou SK (2005) Colistin: The revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections. Clin Infect Dis 40(9):1333\u20131341","journal-title":"Clin Infect Dis"},{"key":"12280_CR54","doi-asserted-by":"publisher","first-page":"107605","DOI":"10.1016\/j.micpath.2025.107605","volume":"204","author":"R Sharma","year":"2025","unstructured":"Sharma R, Lakhanpal D (2025) Acinetobacter baumannii: A comprehensive review of global epidemiology, clinical implications, host interactions, mechanisms of antimicrobial resistance and mitigation strategies. Microb Pathog 204:107605. https:\/\/doi.org\/10.1016\/j.micpath.2025.107605","journal-title":"Microb Pathog"},{"issue":"2","key":"12280_CR55","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1016\/j.diagmicrobio.2009.05.019","volume":"65","author":"CH Rodriguez","year":"2009","unstructured":"Rodriguez CH, Bombicino K, Granados G, Nastro M, Vay C, Famiglietti A (2009) Selection of colistin-resistant Acinetobacter baumannii isolates in postneurosurgical meningitis in an intensive care unit with high presence of heteroresistance to colistin. Diagn Microbiol Infect Dis 65(2):188\u2013191. https:\/\/doi.org\/10.1016\/j.diagmicrobio.2009.05.019","journal-title":"Diagn Microbiol Infect Dis"},{"key":"12280_CR56","doi-asserted-by":"publisher","first-page":"e05093","DOI":"10.1128\/spectrum.05093-22","volume":"11","author":"H Kon","year":"2023","unstructured":"Kon H, Hameir A, Nutman A, Temkin E, Keren Paz A, Lellouche J, Schwartz D, Weiss DS, Kaye KS, Daikos GL, Skiada A, Durante-Mangoni E, Benattar D, Yahav Y, Daitch D, Bernardo V, Iossa M, Friberg D, Theuretzbacher LE, Leibovici U, Dickstein L, Pollak Y, Mendelsohn D, Paul S, M., Carmeli Y (2023) Prevalence and clinical consequences of colistin heteroresistance and evolution into full resistance in carbapenem-resistant Acinetobacter baumannii. Microbiol Spectr 11:e05093\u2013e05022. https:\/\/doi.org\/10.1128\/spectrum.05093-22","journal-title":"Microbiol Spectr"},{"issue":"1","key":"12280_CR57","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1007\/s10096-024-04988-4","volume":"44","author":"A Zulfiqar","year":"2025","unstructured":"Zulfiqar A, Hanif F, Irfan R, Qasim A, Usman J (2025) Incidence of colistin heteroresistance among carbapenem-resistant Acinetobacter baumannii clinical isolates in a tertiary care hospital in Pakistan. Eur J Clin Microbiol Infect diseases: official publication Eur Soc Clin Microbiol 44(1):151\u2013158. https:\/\/doi.org\/10.1007\/s10096-024-04988-4","journal-title":"Eur J Clin Microbiol Infect diseases: official publication Eur Soc Clin Microbiol"},{"issue":"1","key":"12280_CR58","doi-asserted-by":"publisher","first-page":"e280923221542","DOI":"10.2174\/0115701638253395230919112548","volume":"21","author":"I Pakzad","year":"2024","unstructured":"Pakzad I, Yarkarami F, Kalani BS, Shafieian M, Hematian A (2024) Inhibitory Effects of Carvacrol on Biofilm Formation in Colistin Heteroresistant Acinetobacter baumannii Clinical Isolates. Curr Drug Discov Technol 21(1):e280923221542. https:\/\/doi.org\/10.2174\/0115701638253395230919112548","journal-title":"Curr Drug Discov Technol"},{"issue":"4","key":"12280_CR59","doi-asserted-by":"publisher","first-page":"dkag076","DOI":"10.1093\/jac\/dkag076","volume":"81","author":"B Sancak","year":"2026","unstructured":"Sancak B, K\u0131rba\u015f E, Ari O, Durmaz R (2026) Genomic characterization of colistin heteroresistance in Acinetobacter baumannii: Evidence for lpxD deletion and collateral sensitivity. J Antimicrob Chemother 81(4):dkag076. https:\/\/doi.org\/10.1093\/jac\/dkag076","journal-title":"J Antimicrob Chemother"},{"issue":"1","key":"12280_CR60","doi-asserted-by":"publisher","first-page":"48","DOI":"10.3390\/antibiotics10010048","volume":"10","author":"F Sacco","year":"2021","unstructured":"Sacco F, Visca P, Runci F, Antonelli G, Raponi G (2021) Susceptibility Testing of Colistin for Acinetobacter baumannii: How Far Are We from the Truth? Antibiotics 10(1):48. https:\/\/doi.org\/10.3390\/antibiotics10010048","journal-title":"Antibiotics"},{"key":"12280_CR61","doi-asserted-by":"publisher","first-page":"101633","DOI":"10.1016\/j.nmni.2025.101633","volume":"67","author":"A Hematian","year":"2025","unstructured":"Hematian A, Karami-Zarandi M, Rahdar HA, Heidari H, Kazemian H (2025) Investigation of colistin heteroresistance in multidrug-resistant Acinetobacter baumannii clinical isolates. New Microbes New Infections 67:101633. https:\/\/doi.org\/10.1016\/j.nmni.2025.101633","journal-title":"New Microbes New Infections"},{"key":"12280_CR62","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s12929-023-00914-6","volume":"30","author":"J Jo","year":"2023","unstructured":"Jo J, Kwon KT, Ko KS (2023) Multiple heteroresistance to tigecycline and colistin in Acinetobacter baumannii isolates and its implications for combined antibiotic treatment. J Biomed Sci 30:37. https:\/\/doi.org\/10.1186\/s12929-023-00914-6","journal-title":"J Biomed Sci"},{"issue":"1","key":"12280_CR63","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1128\/AAC.00766-07","volume":"52","author":"JS Hawley","year":"2008","unstructured":"Hawley JS, Murray CK, Jorgensen JH (2008) Colistin heteroresistance in Acinetobacter and its association with previous colistin therapy. Antimicrob Agents Chemother 52(1):351\u2013352","journal-title":"Antimicrob Agents Chemother"},{"issue":"2","key":"12280_CR64","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1016\/j.diagmicrobio.2018.01.028","volume":"91","author":"P Srinivas","year":"2018","unstructured":"Srinivas P, Hunt LN, Pouch SM, Thomas K, Goff DA, Pancholi P, Balada-Llasat JM, Bauer KA (2018) Detection of colistin heteroresistance in Acinetobacter baumannii from blood and respiratory isolates. Diagn Microbiol Infect Dis 91(2):194\u2013198. https:\/\/doi.org\/10.1016\/j.diagmicrobio.2018.01.028","journal-title":"Diagn Microbiol Infect Dis"},{"issue":"2","key":"12280_CR65","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.jinf.2008.11.002","volume":"58","author":"W Yau","year":"2009","unstructured":"Yau W, Owen RJ, Poudyal A, Bell JM, Turnidge JD, Yu HH, Nation RL, Li J (2009) Colistin hetero-resistance in multidrug-resistant Acinetobacter baumannii clinical isolates from the Western Pacific region in the SENTRY antimicrobial surveillance programme. J Infect 58(2):138\u2013144. https:\/\/doi.org\/10.1016\/j.jinf.2008.11.002","journal-title":"J Infect"},{"issue":"4","key":"12280_CR66","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1093\/jac\/dkr007","volume":"66","author":"G Meletis","year":"2011","unstructured":"Meletis G, Tzampaz E, Sianou E, Tzavaras I, Sofianou D (2011) Colistin heteroresistance in carbapenemase-producing Klebsiella pneumoniae. J Antimicrob Chemother 66(4):946\u2013947. https:\/\/doi.org\/10.1093\/jac\/dkr007","journal-title":"J Antimicrob Chemother"},{"issue":"6","key":"12280_CR67","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1093\/jac\/dkn425","volume":"62","author":"A Poudyal","year":"2008","unstructured":"Poudyal A, Howden BP, Bell JM, Gao W, Owen RJ, Turnidge JD, Nation RL, Li J (2008) In vitro pharmacodynamics of colistin against multidrug-resistant Klebsiella pneumoniae. J Antimicrob Chemother 62(6):1311\u20131318. https:\/\/doi.org\/10.1093\/jac\/dkn425","journal-title":"J Antimicrob Chemother"},{"key":"12280_CR68","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.jgar.2017.08.002","volume":"11","author":"E Juh\u00e1sz","year":"2017","unstructured":"Juh\u00e1sz E, Iv\u00e1n M, Pint\u00e9r E, Pongr\u00e1cz J, Krist\u00f3f K (2017) Colistin resistance among blood culture isolates at a tertiary care centre in Hungary. J global Antimicrob Resist 11:167\u2013170. https:\/\/doi.org\/10.1016\/j.jgar.2017.08.002","journal-title":"J global Antimicrob Resist"},{"issue":"12","key":"12280_CR69","doi-asserted-by":"publisher","first-page":"4106","DOI":"10.1128\/JCM.02129-13","volume":"51","author":"D Landman","year":"2013","unstructured":"Landman D, Salamera J, Quale J (2013) Irreproducible and uninterpretable Polymyxin B MICs for Enterobacter cloacae and Enterobacter aerogenes. J Clin Microbiol 51(12):4106\u20134111. https:\/\/doi.org\/10.1128\/JCM.02129-13","journal-title":"J Clin Microbiol"},{"issue":"11","key":"12280_CR70","doi-asserted-by":"publisher","first-page":"3058","DOI":"10.1093\/jac\/dkw260","volume":"71","author":"F Gu\u00e9rin","year":"2016","unstructured":"Gu\u00e9rin F, Isnard C, Sinel C, Morand P, Dhalluin A, Cattoir V, Giard JC (2016) Cluster-dependent colistin hetero-resistance in Enterobacter cloacae complex. J Antimicrob Chemother 71(11):3058\u20133061. https:\/\/doi.org\/10.1093\/jac\/dkw260","journal-title":"J Antimicrob Chemother"},{"issue":"1","key":"12280_CR71","doi-asserted-by":"publisher","first-page":"10876","DOI":"10.1038\/s41598-020-67820-x","volume":"10","author":"RT Ni","year":"2020","unstructured":"Ni RT, Onishi M, Mizusawa M, Kitagawa R, Kishino T, Matsubara F, Tsuchiya T, Kuroda T, Ogawa W (2020) The role of RND-type efflux pumps in multidrug-resistant mutants of Klebsiella pneumoniae. Sci Rep 10(1):10876. https:\/\/doi.org\/10.1038\/s41598-020-67820-x","journal-title":"Sci Rep"},{"issue":"4","key":"12280_CR72","doi-asserted-by":"publisher","first-page":"a025387","DOI":"10.1101\/cshperspect.a025387","volume":"6","author":"TH Grossman","year":"2016","unstructured":"Grossman TH (2016) Tetracycline Antibiotics and Resistance. Cold Spring Harbor Perspect Med 6(4):a025387. https:\/\/doi.org\/10.1101\/cshperspect.a025387","journal-title":"Cold Spring Harbor Perspect Med"},{"issue":"1","key":"12280_CR73","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1093\/jac\/dku340","volume":"70","author":"S Bialek-Davenet","year":"2015","unstructured":"Bialek-Davenet S, Lavigne JP, Guyot K, Mayer N, Tournebize R, Brisse S, Leflon-Guibout V, Nicolas-Chanoine MH (2015) Differential contribution of AcrAB and OqxAB efflux pumps to multidrug resistance and virulence in Klebsiella pneumoniae. J Antimicrob Chemother 70(1):81\u201388. https:\/\/doi.org\/10.1093\/jac\/dku340","journal-title":"J Antimicrob Chemother"},{"issue":"1","key":"12280_CR74","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41426-018-0040-z","volume":"7","author":"J Zheng","year":"2018","unstructured":"Zheng J, Lin Z, Sun X, Lin W, Chen Z, Wu Y, Qi G, Deng Q, Qu D, Yu Z (2018) Overexpression of OqxAB and MacAB efflux pumps contributes to eravacycline resistance and heteroresistance in clinical isolates of Klebsiella pneumoniae. Emerg Microbes Infections 7(1):1\u201311. https:\/\/doi.org\/10.1038\/s41426-018-0040-z","journal-title":"Emerg Microbes Infections"},{"key":"12280_CR75","doi-asserted-by":"publisher","first-page":"2178","DOI":"10.3389\/fmicb.2021.706681","volume":"12","author":"Q Zhang","year":"2021","unstructured":"Zhang Q, Lin L, Pan Y, Chen J (2021) Characterization of tigecycline-heteroresistant Klebsiella pneumoniae clinical isolates from a Chinese tertiary care teaching hospital. Front Microbiol 12:2178. https:\/\/doi.org\/10.3389\/fmicb.2021.706681","journal-title":"Front Microbiol"},{"issue":"2","key":"12280_CR76","doi-asserted-by":"publisher","first-page":"e00152","DOI":"10.1128\/Spectrum.00152-21","volume":"9","author":"Y Tian","year":"2021","unstructured":"Tian Y, Zhang Q, Wen L, Chen J (2021) Combined effect of polymyxin B and tigecycline to overcome heteroresistance in carbapenem-resistant Klebsiella pneumoniae. Microbiol Spectr 9(2):e00152\u2013e00121. https:\/\/doi.org\/10.1128\/Spectrum.00152-21","journal-title":"Microbiol Spectr"},{"issue":"1","key":"12280_CR77","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1080\/22221751.2019.1601031","volume":"8","author":"H Liu","year":"2019","unstructured":"Liu H, Jia X, Zou H, Sun S, Li S, Wang Y, Xia Y (2019) Detection and characterization of tigecycline heteroresistance in E. cloacae: clinical and microbiological findings. Emerg microbes infections 8(1):564\u2013574. https:\/\/doi.org\/10.1080\/22221751.2019.1601031","journal-title":"Emerg microbes infections"},{"issue":"2","key":"12280_CR78","doi-asserted-by":"publisher","first-page":"e01010","DOI":"10.1128\/Spectrum.01010-21","volume":"9","author":"J Jo","year":"2021","unstructured":"Jo J, Ko KS (2021) Tigecycline heteroresistance and resistance mechanism in clinical isolates of Acinetobacter baumannii. Microbiol Spectr 9(2):e01010\u2013e01021. https:\/\/doi.org\/10.1128\/Spectrum.01010-21","journal-title":"Microbiol Spectr"},{"issue":"6","key":"12280_CR79","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1093\/jac\/dkaa048","volume":"75","author":"K Tan","year":"2020","unstructured":"Tan K, Nguyen J, Nguyen K, Huse HK, Nieberg PH, Wong-Beringer A (2020) Prevalence of the carbapenem-heteroresistant phenotype among ESBL-producing Escherichia coli and Klebsiella pneumoniae clinical isolates. J Antimicrob Chemother 75(6):1506\u20131512. https:\/\/doi.org\/10.1093\/jac\/dkaa048","journal-title":"J Antimicrob Chemother"},{"issue":"1","key":"12280_CR80","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1007\/s10096-017-3138-x","volume":"37","author":"AEB da Silva","year":"2018","unstructured":"da Silva AEB, Martins AF, Nodari CS, Magagnin CM, Barth AL (2018) Carbapenem-heteroresistance among isolates of the Enterobacter cloacae complex: is it a real concern? Eur J Clin Microbiol Infect diseases: official publication Eur Soc Clin Microbiol 37(1):185\u2013186. https:\/\/doi.org\/10.1007\/s10096-017-3138-x","journal-title":"Eur J Clin Microbiol Infect diseases: official publication Eur Soc Clin Microbiol"},{"issue":"7","key":"12280_CR81","doi-asserted-by":"publisher","first-page":"2601","DOI":"10.1128\/JCM.02134-09","volume":"48","author":"S Pournaras","year":"2010","unstructured":"Pournaras S, Kristo I, Vrioni G, Ikonomidis A, Poulou A, Petropoulou D, Tsakris A (2010) Characteristics of meropenem heteroresistance in Klebsiella pneumoniae carbapenemase (KPC)-producing clinical isolates of K. pneumoniae. J Clin Microbiol 48(7):2601\u20132604. https:\/\/doi.org\/10.1128\/JCM.02134-09","journal-title":"J Clin Microbiol"},{"issue":"11","key":"12280_CR82","doi-asserted-by":"publisher","first-page":"4089","DOI":"10.1128\/JCM.01130-10","volume":"48","author":"M Tato","year":"2010","unstructured":"Tato M, Morosini M, Garc\u00eda L, Albert\u00ed S, Coque MT, Cant\u00f3n R (2010) Carbapenem Heteroresistance in VIM-1-producing Klebsiella pneumoniae isolates belonging to the same clone: consequences for routine susceptibility testing. J Clin Microbiol 48(11):4089\u20134093. https:\/\/doi.org\/10.1128\/JCM.01130-10","journal-title":"J Clin Microbiol"},{"issue":"Pt 1","key":"12280_CR83","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1099\/jmm.0.46816-0","volume":"56","author":"S Pournaras","year":"2007","unstructured":"Pournaras S, Ikonomidis A, Markogiannakis A, Spanakis N, Maniatis AN, Tsakris A (2007) Characterization of clinical isolates of Pseudomonas aeruginosa heterogeneously resistant to carbapenems. J Med Microbiol 56(Pt 1):66\u201370. https:\/\/doi.org\/10.1099\/jmm.0.46816-0","journal-title":"J Med Microbiol"},{"issue":"3","key":"12280_CR84","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/j.ijantimicag.2017.10.014","volume":"51","author":"J He","year":"2018","unstructured":"He J, Jia X, Yang S, Xu X, Sun K, Li C, Yang T, Zhang L (2018) Heteroresistance to carbapenems in invasive Pseudomonas aeruginosa infections. Int J Antimicrob Agents 51(3):413\u2013421. https:\/\/doi.org\/10.1016\/j.ijantimicag.2017.10.014","journal-title":"Int J Antimicrob Agents"},{"issue":"6","key":"12280_CR85","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1016\/j.ijantimicag.2012.01.015","volume":"39","author":"F Fern\u00e1ndez Cuenca","year":"2012","unstructured":"Fern\u00e1ndez Cuenca F, S\u00e1nchez MdelC, Caballero-Moyano FJ, Vila J, Mart\u00ednez-Mart\u00ednez L, Bou G, Ba\u00f1o JR, Pascual A (2012) Prevalence and analysis of microbiological factors associated with phenotypic heterogeneous resistance to carbapenems in Acinetobacter baumannii. Int J Antimicrob Agents 39(6):472\u2013477. https:\/\/doi.org\/10.1016\/j.ijantimicag.2012.01.015","journal-title":"Int J Antimicrob Agents"},{"issue":"12","key":"12280_CR86","doi-asserted-by":"publisher","first-page":"4055","DOI":"10.1128\/JCM.00959-09","volume":"47","author":"A Ikonomidis","year":"2009","unstructured":"Ikonomidis A, Neou E, Gogou V, Vrioni G, Tsakris A, Pournaras S (2009) Heteroresistance to meropenem in carbapenem-susceptible Acinetobacter baumannii. J Clin Microbiol 47(12):4055\u20134059. https:\/\/doi.org\/10.1128\/JCM.00959-09","journal-title":"J Clin Microbiol"},{"issue":"2","key":"12280_CR87","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1590\/s0036-46652009000200010","volume":"51","author":"SV Superti","year":"2009","unstructured":"Superti SV, Martins DdeS, Caier\u00e3o J, Soares FdaS, Prochnow T, Zavascki AP (2009) Indications of carbapenem resistance evolution through heteroresistance as an intermediate stage in Acinetobacter baumannii after carbapenem administration. Rev Inst Med Trop Sao Paulo 51(2):111\u2013113. https:\/\/doi.org\/10.1590\/s0036-46652009000200010","journal-title":"Rev Inst Med Trop Sao Paulo"},{"issue":"2","key":"12280_CR88","doi-asserted-by":"publisher","first-page":"e01968","DOI":"10.1128\/AAC.01968-17","volume":"62","author":"MA Hackel","year":"2018","unstructured":"Hackel MA, Tsuji M, Yamano Y, Echols R, Karlowsky JA, Sahm DF (2018) In vitro activity of the siderophore cephalosporin, cefiderocol, against carbapenem-nonsusceptible and multidrug-resistant isolates of Gram-negative bacilli collected worldwide in 2014 to 2016. Antimicrob Agents Chemother 62(2):e01968\u2013e01917. https:\/\/doi.org\/10.1128\/AAC.01968-17","journal-title":"Antimicrob Agents Chemother"},{"key":"12280_CR89","doi-asserted-by":"publisher","unstructured":"Paul, M., Carrara, E., Retamar, P., T\u00e4ngd\u00e9n, T., Bitterman, R., Bonomo, R. A., de Waele, J., Daikos, G. L., Akova, M., Harbarth, S., Pulcini, C., Garnacho-Montero,J., Seme, K., Tumbarello, M., Lindemann, P. C., Gandra, S., Yu, Y., Bassetti, M.,Mouton, J. W., Tacconelli, E., \u2026 Rodr\u00edguez-Ba\u00f1o, J. (2022). European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli (endorsed by European society of intensive care medicine). Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 28(4), 521\u2013547. https:\/\/doi.org\/10.1016\/j.cmi.2021.11.025","DOI":"10.1016\/j.cmi.2021.11.025"},{"issue":"2","key":"12280_CR90","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/S1473-3099(20)30796-9","volume":"21","author":"M Bassetti","year":"2021","unstructured":"Bassetti M, Echols R, Matsunaga Y, Ariyasu M, Doi Y, Ferrer R, Lodise TP, Naas T, Niki Y, Paterson DL, Portsmouth S, Torre-Cisneros J, Toyoizumi K, Wunderink RG, Nagata TD (2021) Efficacy and safety of cefiderocol or best available therapy for the treatment of serious infections caused by carbapenem-resistant Gram-negative bacteria (CREDIBLE-CR): a randomised, open-label, multicentre, pathogen-focused, descriptive, phase 3 trial. Lancet Infect Dis 21(2):226\u2013240. https:\/\/doi.org\/10.1016\/S1473-3099(20)30796-9","journal-title":"Lancet Infect Dis"},{"issue":"5","key":"12280_CR91","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/S1473-3099(21)00194-8","volume":"21","author":"JE Choby","year":"2021","unstructured":"Choby JE, Ozturk T, Satola SW, Jacob JT, Weiss DS (2021) Widespread cefiderocol heteroresistance in carbapenem-resistant Gram-negative pathogens. Lancet Infect Dis 21(5):597\u2013598. https:\/\/doi.org\/10.1016\/S1473-3099(21)00194-8","journal-title":"Lancet Infect Dis"},{"issue":"7","key":"12280_CR92","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1016\/S1473-3099(21)00328-5","volume":"21","author":"M Bassetti","year":"2021","unstructured":"Bassetti M, Echols R, Koren A, Karas A, Longshaw C, Yamano Y, Den Nagata T (2021) Placing in-vitro heteroresistance in the context of clinical results. Lancet Infect Dis 21(7):908\u2013909. https:\/\/doi.org\/10.1016\/S1473-3099(21)00328-5","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"12280_CR93","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1093\/jac\/40.1.135","volume":"40","author":"K Hiramatsu","year":"1997","unstructured":"Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T, Tenover FC (1997) Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother 40(1):135\u2013136. https:\/\/doi.org\/10.1093\/jac\/40.1.135","journal-title":"J Antimicrob Chemother"},{"key":"12280_CR94","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.jgar.2024.02.002","volume":"37","author":"M Keikha","year":"2024","unstructured":"Keikha M, Karbalaei M (2024) Global distribution of heterogeneous vancomycin-intermediate Staphylococcus aureus strains (1997\u20132021): A systematic review and meta-analysis. J Global Antimicrob Resist 37:11\u201321. https:\/\/doi.org\/10.1016\/j.jgar.2024.02.002","journal-title":"J Global Antimicrob Resist"},{"key":"12280_CR95","doi-asserted-by":"publisher","first-page":"11251","DOI":"10.1038\/s41467-025-66118-8","volume":"16","author":"N Fatsis-Kavalopoulos","year":"2025","unstructured":"Fatsis-Kavalopoulos N, Kim YK, Chong YP, Bae S, Lim SY, Kim YS, Andersson DI (2025) Vancomycin heteroresistance (hVISA) in MRSA links to treatment failure and supports a revised PAP-AUC threshold. Nat Commun 16:11251. https:\/\/doi.org\/10.1038\/s41467-025-66118-8","journal-title":"Nat Commun"},{"issue":"7","key":"12280_CR96","doi-asserted-by":"publisher","first-page":"e88122","DOI":"10.7759\/cureus.88122","volume":"17","author":"A Agarwal","year":"2025","unstructured":"Agarwal A, Singhal L, Kour I, Gupta P, Kaur N, Vasesi D, Gupta V (2025) Prevalence and detection of heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) among clinical isolates: A comparative evaluation of screening methods. Cureus 17(7):e88122. https:\/\/doi.org\/10.7759\/cureus.88122","journal-title":"Cureus"},{"issue":"1","key":"12280_CR97","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1186\/s13756-022-01140-9","volume":"11","author":"YR Kang","year":"2022","unstructured":"Kang YR, Kim SH, Chung DR, Ko JH, Huh K, Cho SY, Kang CI, Peck KR (2022) Impact of vancomycin use trend change due to the availability of alternative antibiotics on the prevalence of Staphylococcus aureus with reduced vancomycin susceptibility: a 14-year retrospective study. Antimicrob Resist Infect control 11(1):101. https:\/\/doi.org\/10.1186\/s13756-022-01140-9","journal-title":"Antimicrob Resist Infect control"},{"issue":"9","key":"12280_CR98","doi-asserted-by":"publisher","first-page":"4252","DOI":"10.1128\/AAC.00380-13","volume":"57","author":"AM Casapao","year":"2013","unstructured":"Casapao AM, Leonard SN, Davis SL, Lodise TP, Patel N, Goff DA, LaPlante KL, Potoski BA, Rybak MJ (2013) Clinical Outcomes in Patients with Heterogeneous Vancomycin-Intermediate Staphylococcus aureus Bloodstream Infection. Antimicrob Agents Chemother 57(9):4252\u20134259. https:\/\/doi.org\/10.1128\/AAC.00380-13","journal-title":"Antimicrob Agents Chemother"},{"issue":"3","key":"12280_CR99","doi-asserted-by":"publisher","first-page":"235","DOI":"10.3343\/alm.2016.36.3.235","volume":"36","author":"YR Koh","year":"2016","unstructured":"Koh YR, Kim KH, Chang CL, Yi J (2016) Prevalence and Clinical Impact of Heterogeneous Vancomycin-Intermediate Staphylococcus aureus Isolated From Hospitalized Patients. Annals Lab Med 36(3):235\u2013243. https:\/\/doi.org\/10.3343\/alm.2016.36.3.235","journal-title":"Annals Lab Med"},{"issue":"3","key":"12280_CR100","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1128\/AAC.02388-15","volume":"60","author":"KC Claeys","year":"2016","unstructured":"Claeys KC, Lagnf AM, Hallesy JA, Compton MT, Gravelin AL, Davis SL, Rybak MJ (2016) Pneumonia Caused by Methicillin-Resistant Staphylococcus aureus: Does Vancomycin Heteroresistance Matter? Antimicrob Agents Chemother 60(3):1708\u20131716. https:\/\/doi.org\/10.1128\/AAC.02388-15","journal-title":"Antimicrob Agents Chemother"},{"issue":"3","key":"12280_CR101","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1016\/j.jacc.2016.10.066","volume":"69","author":"TJ Cahill","year":"2017","unstructured":"Cahill TJ, Baddour LM, Habib G, Hoen B, Salaun E, Pettersson GB, Sch\u00e4fers HJ, Prendergast BD (2017) Challenges in Infective Endocarditis. J Am Coll Cardiol 69(3):325\u2013344. https:\/\/doi.org\/10.1016\/j.jacc.2016.10.066","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"12280_CR102","doi-asserted-by":"publisher","first-page":"7868","DOI":"10.1038\/s41598-018-26277-9","volume":"8","author":"CC Yang","year":"2018","unstructured":"Yang CC, Sy CL, Huang YC, Shie SS, Shu JC, Hsieh PH, Hsiao CH, Chen CJ (2018) Risk factors of treatment failure and 30-day mortality in patients with bacteremia due to MRSA with reduced vancomycin susceptibility. Sci Rep 8(1):7868. https:\/\/doi.org\/10.1038\/s41598-018-26277-9","journal-title":"Sci Rep"},{"issue":"8","key":"12280_CR103","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.1093\/jac\/dks131","volume":"67","author":"KH Park","year":"2012","unstructured":"Park KH, Kim ES, Kim HS, Park SJ, Bang KM, Park HJ, Park SY, Moon SM, Chong YP, Kim SH, Lee SO, Choi SH, Jeong JY, Kim MN, Woo JH, Kim YS (2012) Comparison of the clinical features, bacterial genotypes and outcomes of patients with bacteraemia due to heteroresistant vancomycin-intermediate Staphylococcus aureus and vancomycin-susceptible Staphylococcus aureus. J Antimicrob Chemother 67(8):1843\u20131849. https:\/\/doi.org\/10.1093\/jac\/dks131","journal-title":"J Antimicrob Chemother"},{"issue":"1","key":"12280_CR104","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1186\/s12879-026-13102-2","volume":"26","author":"Y Liu","year":"2026","unstructured":"Liu Y, Zhou C, Zhong G, Zeng J, Pu J, Chen C, He Y, Huang B (2026) Evaluation of a simplified agar-based population analysis profiling as a practical alternative for detecting heteroresistance in clinical bacterial isolates. BMC Infect Dis 26(1):917. https:\/\/doi.org\/10.1186\/s12879-026-13102-2","journal-title":"BMC Infect Dis"},{"key":"12280_CR105","doi-asserted-by":"publisher","first-page":"4239177","DOI":"10.1155\/bmri\/4239177","volume":"2026","author":"ZR Rad","year":"2026","unstructured":"Rad ZR, Rad ZR, Goudarzi H, Goudarzi M, Javidi M, Sharahi JY, Kargar M, Hashemi A (2026) An Investigation of Colistin Heteroresistance in Klebsiella pneumoniae Isolates in Iran. Biomed Res Int 2026:4239177. https:\/\/doi.org\/10.1155\/bmri\/4239177","journal-title":"Biomed Res Int"},{"issue":"1","key":"12280_CR106","doi-asserted-by":"publisher","first-page":"e2515303123","DOI":"10.1073\/pnas.2515303123","volume":"123","author":"J Hernandez-Bird","year":"2026","unstructured":"Hernandez-Bird J, He B, VanOtterloo LM, Billings EB, Huo W, Teodoro GIC, Echlin H, Rosch JM, Trent MS, Isberg RR (2026) Resistance, heteroresistance, and fitness costs drive colistin treatment failure during Acinetobacter baumannii pneumonia. Proc Natl Acad Sci USA 123(1):e2515303123. https:\/\/doi.org\/10.1073\/pnas.2515303123","journal-title":"Proc Natl Acad Sci USA"},{"key":"12280_CR107","doi-asserted-by":"publisher","DOI":"10.1016\/j.tig.2026.03.008","author":"Q Liu","year":"2026","unstructured":"Liu Q, Lyu L-D (2026) Heterogeneity in microbial antibiotic responses: Genetic basis and within-host evolution. Trends Genet. https:\/\/doi.org\/10.1016\/j.tig.2026.03.008. Advance online publication","journal-title":"Trends Genet"},{"key":"12280_CR108","doi-asserted-by":"publisher","first-page":"e01788","DOI":"10.1128\/jcm.01788-25","volume":"0","author":"I Brukner","year":"2025","unstructured":"Brukner I, Oughton M (2025) The sampling bottleneck in antimicrobial susceptibility testing: Consequences and paths forward. J Clin Microbiol 0:e01788\u2013e01725. https:\/\/doi.org\/10.1128\/jcm.01788-25","journal-title":"J Clin Microbiol"}],"container-title":["Molecular Biology Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11033-026-12280-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11033-026-12280-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11033-026-12280-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T08:39:50Z","timestamp":1783067990000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11033-026-12280-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":108,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["12280"],"URL":"https:\/\/doi.org\/10.1007\/s11033-026-12280-1","relation":{},"ISSN":["0301-4851","1573-4978"],"issn-type":[{"value":"0301-4851","type":"print"},{"value":"1573-4978","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]},"assertion":[{"value":"11 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1078"}}