{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:41:18Z","timestamp":1791996078867,"version":"4.4.0"},"reference-count":45,"publisher":"American Society for Microbiology","issue":"6","license":[{"start":{"date-parts":[[2009,6,1]],"date-time":"2009-06-01T00:00:00Z","timestamp":1243814400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2009,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Vancomycin MICs (V-MIC) and the frequency of heteroresistant vancomycin-intermediate\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    (hVISA) isolates are increasing among methicillin (meticillin)-resistant\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    (MRSA) isolates, but their relevance remains uncertain. We compared the V-MIC (Etest) and the frequency of hVISA (Etest macromethod) for all MRSA blood isolates saved over an 11-year span and correlated the results with the clinical outcome. We tested 489 isolates: 61, 55, 187, and 186 isolates recovered in 1996-1997, 2000, 2002-2003, and 2005-2006, respectively. The V-MICs were \u22641, 1.5, 2, and 3 \u03bcg\/ml for 74 (15.1%), 355 (72.6%), 50 (10.2%), and 10 (2.1%) isolates, respectively. We detected hVISA in 0\/74, 48\/355 (13.5%), 15\/50 (30.0%), and 8\/10 (80.0%) isolates with V-MICs of \u22641, 1.5, 2, and 3 \u03bcg\/ml, respectively (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.001). The V-MIC distribution and the hVISA frequency were stable over the 11-year period. Most patients (89.0%) received vancomycin. The mortality rate (evaluated with 285 patients for whose isolates the trough V-MIC was \u226510 \u03bcg\/ml) was comparable for patients whose isolates had V-MICs of \u22641 and 1.5 \u03bcg\/ml (19.4% and 27.0%, respectively;\n                    <jats:italic>P<\/jats:italic>\n                    = 0.2) but higher for patients whose isolates had V-MICs of \u22652 \u03bcg\/ml (47.6%;\n                    <jats:italic>P<\/jats:italic>\n                    = 0.03). However, the impact of V-MIC and hVISA status on mortality or persistent (\u22657 days) bacteremia was not substantiated by multivariate analysis. Staphylococcal chromosome cassette\n                    <jats:italic>mec<\/jats:italic>\n                    (SCC\n                    <jats:italic>mec<\/jats:italic>\n                    ) typing of 261 isolates (including all hVISA isolates) revealed that 93.0% of the hVISA isolates were SCC\n                    <jats:italic>mec<\/jats:italic>\n                    type II. These findings demonstrate that the V-MIC distribution and hVISA frequencies were stable over an 11-year span. A V-MIC of \u22652 \u03bcg\/ml was associated with a higher rate of mortality by univariate analysis, but the relevance of the V-MIC and the presence of hVISA remain uncertain. A multicenter prospective randomized study by the use of standardized methods is needed to evaluate the relevance of hVISA and determine the optimal treatment of patients whose isolates have V-MICs of \u22652.0 \u03bcg\/ml.\n                  <\/jats:p>","DOI":"10.1128\/jcm.02135-08","type":"journal-article","created":{"date-parts":[[2009,4,15]],"date-time":"2009-04-15T20:58:50Z","timestamp":1239829130000},"page":"1640-1644","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":138,"title":["Vancomycin MIC plus Heteroresistance and Outcome of Methicillin-Resistant\n                    <i>Staphylococcus aureus<\/i>\n                    Bacteremia: Trends over 11 Years"],"prefix":"10.1128","volume":"47","author":[{"given":"Adina C.","family":"Musta","sequence":"first","affiliation":[{"name":"Department of Medicine, Infectious Diseases, St. John Hospital and Medical Center, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Riederer","sequence":"additional","affiliation":[{"name":"Department of Medicine, Infectious Diseases, St. John Hospital and Medical Center, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Shemes","sequence":"additional","affiliation":[{"name":"Department of Medicine, Infectious Diseases, St. John Hospital and Medical Center, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Chase","sequence":"additional","affiliation":[{"name":"Department of Medicine, Infectious Diseases, St. John Hospital and Medical Center, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinson","family":"Jose","sequence":"additional","affiliation":[{"name":"Department of Medicine, Infectious Diseases, St. John Hospital and Medical Center, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard B.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Infectious Diseases, St. John Hospital and Medical Center, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riad","family":"Khatib","sequence":"additional","affiliation":[{"name":"Department of Medicine, Infectious Diseases, St. John Hospital and Medical Center, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1086\/519474"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.40.3.1109-1112.2002"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.44.2.272-277.2000"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1086\/381093"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00154-08"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02437-06"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1086\/518452"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2007.01912.x"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1590\/S1413-86702007000300009"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1086\/346207"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)07324-8"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2004.00757.x"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1086\/381202"},{"key":"e_1_3_2_15_2","first-page":"661","volume":"186","year":"2002","unstructured":"Hussain, F., S. 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