{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T23:49:05Z","timestamp":1789343345770,"version":"build-2803163510"},"reference-count":30,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>\n                    <jats:italic toggle=\"yes\">Staphylococcus haemolyticus<\/jats:italic>\n                    is frequently associated with infections in hospitalized patients and acts as a reservoir for antibiotic resistance genes. The widespread use of vancomycin in treating serious infections has led to the emergence of heteroresistance to vancomycin in certain\n                    <jats:italic toggle=\"yes\">S. haemolyticus<\/jats:italic>\n                    isolates. This study aimed to determine the rate of heteroresistant vancomycin-intermediate\n                    <jats:italic toggle=\"yes\">S. haemolyticus<\/jats:italic>\n                    (hVISH) among 166 blood isolates collected from patients admitted to Jawaharlal Institute of Postgraduate Medical Education and Research between January 2017 and June 2018. E-test was done to determine vancomycin minimum inhibitory concentration (MIC). Heteroresistance screening was performed using brain heart infusion agar containing 4 \u00b5g\/mL vancomycin (BHIV\n                    <jats:sub>4<\/jats:sub>\n                    ). Confirmation of heteroresistance was performed by population analysis-profile area under curve (PAP-AUC) analysis. Whole-genome sequencing was performed on eight isolates. All isolates were vancomycin-susceptible by E-test, while 18.7% exhibited heteroresistance by PAP-AUC. The sensitivity, specificity, positive predictive value, negative predictive value, and kappa agreement of BHIV\n                    <jats:sub>4<\/jats:sub>\n                    with PAP-AUC were 64.5%, 97.8%, 87%, 92.3%, and 0.692, respectively. Mutational analysis of the eight isolates revealed variations in\n                    <jats:italic toggle=\"yes\">vraSR<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">tcaRAB<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">walKR<\/jats:italic>\n                    , yyc\n                    <jats:italic toggle=\"yes\">HIJ<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">rpoBC<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">lytSR<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">clpP<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">phoR<\/jats:italic>\n                    , PBP\n                    <jats:sub>4<\/jats:sub>\n                    ,\n                    <jats:italic toggle=\"yes\">msrR<\/jats:italic>\n                    ,\n                    <jats:italic toggle=\"yes\">cmk<\/jats:italic>\n                    , and\n                    <jats:italic toggle=\"yes\">mprF<\/jats:italic>\n                    operons, along with novel mutations in cell wall synthesis operons. The rate of hVISH isolation in our study is in agreement with other studies worldwide. As the sensitivity of BHIV\n                    <jats:sub>4<\/jats:sub>\n                    is only moderate, it may be prudent to consider alternate antibiotics if MIC of vancomycin approaches the breakpoint. Furthermore, our analysis revealed multiple mutations within glycopeptide resistance operons, providing a better understanding of the molecular mechanisms underlying heteroresistance in\n                    <jats:italic toggle=\"yes\">S. haemolyticus<\/jats:italic>\n                    and its implications for antimicrobial therapy and surveillance strategies.\n                  <\/jats:p>","DOI":"10.1177\/10766294251389588","type":"journal-article","created":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T01:15:44Z","timestamp":1761354944000},"page":"422-430","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Detection of Heteroresistant Vancomycin-Intermediate\n                    <i>Staphylococcus haemolyticus<\/i>\n                    Among Blood Isolates"],"prefix":"10.1177","volume":"31","author":[{"given":"Meerabai","family":"Manoharan","sequence":"first","affiliation":[{"name":"Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India."},{"name":"Aarupadai Veedu Medical College and Hospital, Vinayaka Mission\u2019s Research Foundation (Deemed to be University), Pondicherry, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujatha","family":"Sistla","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Amberpet","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Texila American University, Lusaka, Zambia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1099\/mic.0.000178"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.05563-11"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmni.2017.05.007"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/781679"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.2144\/fsoa-2020-0179"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s42770-022-00870-7"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12941-017-0238-5"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00042-09"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.4103\/ijmr.IJMR_1976_17"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.5799\/jmid.897119"},{"key":"e_1_3_2_12_2","volume-title":"CLSI supplement M100","author":"CLSI","year":"2018","unstructured":"CLSI. Performance standards for antimicrobial susceptibility testing. In. CLSI supplement M100, 27th edn. Clinical and Laboratory Standards Institute, 2018.","edition":"27"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gky379"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gkz943"},{"key":"e_1_3_2_15_2","unstructured":"Seemann T. ABRicate: Mass screening of contigs for antimicrobial and virulence genes. GitHub. 2017. 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