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The heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) phenotype is associated with therapeutic failure. However, hVISA isolates are usually reported as vancomycin susceptible by routine susceptibility testing procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To detect and characterize the hVISA phenotype in MRSA isolates causing infections in nine Latin American countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluated a total of 1189 vancomycin-susceptible MRSA isolates recovered during 2006\u201308 and 2011\u201314. After an initial screening of hVISA using glycopeptide-supplemented agar strategies, the detection of hVISA was performed by Etest (GRD) and Macro-method (MET). Isolates deemed to be hVISA were subjected to population analysis profile\/AUC (PAP\/AUC) and WGS for further characterization. Finally, we interrogated alterations in predicted proteins associated with the development of the VISA phenotype in both hVISA and vancomycin-susceptible S. aureus (VSSA) genomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 39 MRSA isolates (3.3%) were classified as hVISA (1.4% and 5.6% in MRSA recovered from 2006\u201308 and 2011\u201314, respectively). Most of the hVISA strains (95%) belonged to clonal complex (CC) 5. Only 6\/39 hVISA isolates were categorized as hVISA by PAP\/AUC, with 6 other isolates close (0.87\u20130.89) to the cut-off (0.9). The majority of the 39 hVISA isolates exhibited the Leu-14\u2192Ile (90%) and VraT Glu-156\u2192Gly (90%) amino acid substitutions in WalK. Additionally, we identified 10 substitutions present only in hVISA isolates, involving WalK, VraS, RpoB and RpoC proteins.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The hVISA phenotype exhibits low frequency in Latin America. Amino acid substitutions in proteins involved in cell envelope homeostasis and RNA synthesis were commonly identified. Our results suggest that Etest-based methods are an important alternative for the detection of hVISA clinical isolates.<\/jats:p><\/jats:sec>","DOI":"10.1093\/jac\/dkaa221","type":"journal-article","created":{"date-parts":[[2020,5,26]],"date-time":"2020-05-26T03:18:47Z","timestamp":1590463127000},"page":"2424-2431","source":"Crossref","is-referenced-by-count":17,"title":["Detection of heterogeneous vancomycin intermediate resistance in MRSA isolates from Latin America"],"prefix":"10.1093","volume":"75","author":[{"given":"Betsy E","family":"Castro","sequence":"first","affiliation":[{"name":"Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogot\u00e1, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maritza","family":"Berrio","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Salud, Bogot\u00e1, 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