vancomycin resistance


Summary: Nonsusceptibility of bacteria to the action of VANCOMYCIN, an inhibitor of cell wall synthesis.

Top Publications

  1. Cekin Y, Erman Daloğlu A, Ogunc D, Ozhak Baysan B, Dağlar D, Inan D, et al. Evaluation of vancomycin resistance 3 multiplexed PCR assay for detection of vancomycin-resistant enterococci from rectal swabs. Ann Lab Med. 2013;33:326-30 pubmed publisher
    ..We evaluated the diagnostic performance of Vancomycin Resistance 3 Multiplexed Tandem PCR assay (AusDiagnostics, Australia), a rapid multiplex real-time PCR assay that ..
  2. Watanabe Y, Cui L, Katayama Y, Kozue K, Hiramatsu K. Impact of rpoB mutations on reduced vancomycin susceptibility in Staphylococcus aureus. J Clin Microbiol. 2011;49:2680-4 pubmed publisher
    ..aureus (MRSA) clinical isolates showed decreased vancomycin susceptibilities. These data indicate the involvement of an rpoB mutation in VISA phenotype expression. ..
  3. Huang S, Datta R, Rifas Shiman S, Kleinman K, Placzek H, Lankiewicz J, et al. Colonization with antibiotic-susceptible strains protects against methicillin-resistant Staphylococcus aureus but not vancomycin-resistant enterococci acquisition: a nested case-control study. Crit Care. 2011;15:R210 pubmed publisher
    ..This may be particularly important for populations in whom MRSA infection may be more frequent and severe than MSSA infections, such as ICU patients. ..
  4. Bourdon N, Fines Guyon M, Thiolet J, Maugat S, Coignard B, Leclercq R, et al. Changing trends in vancomycin-resistant enterococci in French hospitals, 2001-08. J Antimicrob Chemother. 2011;66:713-21 pubmed publisher
    ..However, VRE continue to emerge in a growing number of hospitals. ..
  5. Nomura T, Tanimoto K, Shibayama K, Arakawa Y, Fujimoto S, Ike Y, et al. Identification of VanN-type vancomycin resistance in an Enterococcus faecium isolate from chicken meat in Japan. Antimicrob Agents Chemother. 2012;56:6389-92 pubmed publisher
    ..The vancomycin resistance was encoded on a large plasmid (160 kbp) and was expressed constitutively...
  6. Huskins W, Huckabee C, O Grady N, Murray P, Kopetskie H, Zimmer L, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med. 2011;364:1407-18 pubmed publisher
    ..Funded by the National Institute of Allergy and Infectious Diseases and others; STAR*ICU number, NCT00100386.). ..
  7. Meziane Cherif D, Saul F, Haouz A, Courvalin P. Structural and functional characterization of VanG D-Ala:D-Ser ligase associated with vancomycin resistance in Enterococcus faecalis. J Biol Chem. 2012;287:37583-92 pubmed publisher
    d-Alanyl:d-lactate (d-Ala:d-Lac) and d-alanyl:d-serine ligases are key enzymes in vancomycin resistance of Gram-positive cocci...
  8. Arias C, Murray B. The rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol. 2012;10:266-78 pubmed publisher
    ..Finally, we review the most important mechanisms of resistance to the antibiotics that are used to treat vancomycin-resistant enterococci...
  9. Batistão D, Gontijo Filho P, Conceição N, Oliveira A, Ribas R. Risk factors for vancomycin-resistant enterococci colonisation in critically ill patients. Mem Inst Oswaldo Cruz. 2012;107:57-63 pubmed
    ..Even though the clinical relevance of vanC VRE is uncertain, these species are opportunistic pathogens and vanC VRE-colonised patients are a potential epidemiologic reservoir of resistance genes. ..

More Information


  1. Valdezate S, Miranda C, Navarro A, Freitas A, Cabrera J, Carrasco G, et al. Clonal outbreak of ST17 multidrug-resistant Enterococcus faecium harbouring an Inc18-like::Tn1546 plasmid in a haemo-oncology ward of a Spanish hospital. J Antimicrob Chemother. 2012;67:832-6 pubmed publisher
    ..To report a clonal outbreak of ST17 vancomycin-resistant Enterococcus faecium (VREfm) carrying Tn1546 (vanA) in a haemo-oncology ward of a tertiary teaching hospital in the south of Spain (January-September 2009)...
  2. Araújo C, Torres C, Gonçalves A, Carneiro C, Lopez M, Radhouani H, et al. Genetic detection and multilocus sequence typing of vanA-containing Enterococcus strains from mullets fish (Liza ramada). Microb Drug Resist. 2011;17:357-61 pubmed publisher
    ..Mullets fish can excrete VRE in their feces and may be a reservoir for such resistant bacteria that can be transmitted to other animals including humans. ..
  3. Lebreton F, Depardieu F, Bourdon N, Fines Guyon M, Berger P, Camiade S, et al. D-Ala-d-Ser VanN-type transferable vancomycin resistance in Enterococcus faecium. Antimicrob Agents Chemother. 2011;55:4606-12 pubmed publisher
    ..VanN-type resistance was transferable by conjugation to E. faecium. This is the first report of transferable d-Ala-d-Ser-type resistance in E. faecium. ..
  4. Shoji M, Cui L, Iizuka R, Komoto A, Neoh H, Watanabe Y, et al. walK and clpP mutations confer reduced vancomycin susceptibility in Staphylococcus aureus. Antimicrob Agents Chemother. 2011;55:3870-81 pubmed publisher
    ..and yycFG), and a truncating mutation in a proteolytic regulatory gene, clpP, responsible for the raised vancomycin resistance in a laboratory-derived VISA strain, LR5P1-V3...
  5. Antunes A, Bonfanti J, Perez L, Pinto C, Freitas A, Macedo A, et al. High vancomycin resistance among biofilms produced by Staphylococcus species isolated from central venous catheters. Mem Inst Oswaldo Cruz. 2011;106:51-5 pubmed
    ..001). The correlation between the MIC and the MBEC was poor. Based on our results, we recommend that bacterial biofilms be suspected in all cases of CVC infection. ..
  6. Meziane Cherif D, Stogios P, Evdokimova E, Savchenko A, Courvalin P. Structural basis for the evolution of vancomycin resistance D,D-peptidases. Proc Natl Acad Sci U S A. 2014;111:5872-7 pubmed publisher
    b>Vancomycin resistance in Gram-positive bacteria is due to production of cell-wall precursors ending in D-Ala-D-Lac or D-Ala-D-Ser, to which vancomycin exhibits low binding affinities, and to the elimination of the high-affinity ..
  7. Minhas P, Perl T, Carroll K, Shepard J, Shangraw K, Fellerman D, et al. Risk factors for positive admission surveillance cultures for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in a neurocritical care unit. Crit Care Med. 2011;39:2322-9 pubmed publisher
    ..In our setting, in the absence of these risk factors and in patients admitted from home for neurosurgical procedures, routine admission surveillance cultures to the intensive care unit may not be cost-effective. ..
  8. Werner G, Serr A, Schütt S, Schneider C, Klare I, Witte W, et al. Comparison of direct cultivation on a selective solid medium, polymerase chain reaction from an enrichment broth, and the BD GeneOhm™ VanR Assay for identification of vancomycin-resistant enterococci in screening specimens. Diagn Microbiol Infect Dis. 2011;70:512-21 pubmed publisher
    ..The overall sensitivity was 93.1%; the specificity was 87.0% mainly due to false-positive vanB results. Results did not differ between study institutions...
  9. Thati V, Shivannavar C, Gaddad S. Vancomycin resistance among methicillin resistant Staphylococcus aureus isolates from intensive care units of tertiary care hospitals in Hyderabad. Indian J Med Res. 2011;134:704-8 pubmed publisher
    ..The present study aimed at identifying the vancomycin resistance both phenotypically and genotypically among the MRSA isolates from two tertiary care hospitals in ..
  10. Lu C, Chuang Y, Chang H, Chen Y, Wang J, Chang S. Microbiological and clinical characteristics of vancomycin-resistant Enterococcus faecium bacteraemia in Taiwan: implication of sequence type for prognosis. J Antimicrob Chemother. 2012;67:2243-9 pubmed publisher
    ..We aimed to examine whether there were newly introduced clones contributing to this increase and to assess the risk factors for mortality in patients with VREfm bacteraemia...
  11. Babady N, Gilhuley K, Cianciminio Bordelon D, Tang Y. Performance characteristics of the Cepheid Xpert vanA assay for rapid identification of patients at high risk for carriage of vancomycin-resistant Enterococci. J Clin Microbiol. 2012;50:3659-63 pubmed publisher
    ..This assay provides excellent predictive values for prompt identification of VRE-colonized patients in hospitals with relatively high rates of VRE carriage...
  12. Pan S, Wang J, Chen Y, Chang Y, Chen M, Chang S. Incidence of and risk factors for infection or colonization of vancomycin-resistant enterococci in patients in the intensive care unit. PLoS ONE. 2012;7:e47297 pubmed publisher
    ..Strategies to reduce the duration of ICU stay and prudent usage of broad-spectrum antibiotics are the keys to controlling VRE transmission...
  13. Climo M, Yokoe D, Warren D, Perl T, Bolon M, Herwaldt L, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med. 2013;368:533-42 pubmed publisher
    ..Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs)...
  14. Qu T, Yang Q, Shen P, Wei Z, Yu Y. Novel vancomycin-resistance transposon, plasmid replicon types, and virulence factors of vancomycin-resistant Enterococci in Zhejiang, China. Microb Drug Resist. 2012;18:183-8 pubmed publisher
    ..types (pRUM, pRE25, pEF418, and pB82) were more common in VRE isolates, suggesting their association with vancomycin resistance and nosocomial transmission...
  15. Grabsch E, Mahony A, Cameron D, Martin R, Heland M, Davey P, et al. Significant reduction in vancomycin-resistant enterococcus colonization and bacteraemia after introduction of a bleach-based cleaning-disinfection programme. J Hosp Infect. 2012;82:234-42 pubmed publisher
    ..Vancomycin-resistant enterococcus (VRE) colonization and infection have increased at our hospital, despite adherence to standard VRE control guidelines...
  16. Yoon Y, Kim H, Lee W, Lee S, Yang K, Park D, et al. Clinical prediction rule for identifying patients with vancomycin-resistant enterococci (VRE) at the time of admission to the intensive care unit in a low VRE prevalence setting. J Antimicrob Chemother. 2012;67:2963-9 pubmed publisher
  17. Cattoir V, Leclercq R. Twenty-five years of shared life with vancomycin-resistant enterococci: is it time to divorce?. J Antimicrob Chemother. 2013;68:731-42 pubmed publisher
    ..Although so far unsuccessful, dissemination of glycopeptide-resistant Staphylococcus aureus with van genes acquired from resistant enterococci cannot be ruled out...
  18. Howden B, McEvoy C, Allen D, Chua K, Gao W, Harrison P, et al. Evolution of multidrug resistance during Staphylococcus aureus infection involves mutation of the essential two component regulator WalKR. PLoS Pathog. 2011;7:e1002359 pubmed publisher
    ..aureus infections and demonstrates the role played by walKR to increase drug resistance, control metabolism and alter the virulence potential of this pathogen. ..
  19. Chang Y, Chen W, Hsieh P, Chen D, Lee M, Shih H, et al. In vitro activities of daptomycin-, vancomycin-, and teicoplanin-loaded polymethylmethacrylate against methicillin-susceptible, methicillin-resistant, and vancomycin-intermediate strains of Staphylococcus aureus. Antimicrob Agents Chemother. 2011;55:5480-4 pubmed publisher
    ..Regarding the choice of antibiotics for cement loading in the treatment of Staphylococcus aureus infection, teicoplanin was superior in terms of antibacterial effects...
  20. Garcia Migura L, Sanchez Valenzuela A, Jensen L. Presence of glycopeptide-encoding plasmids in enterococcal isolates from food and humans in Denmark. Foodborne Pathog Dis. 2011;8:1191-7 pubmed publisher
    ..faecalis. This article describes the first characterization of MGE from vanA mediated E. faecalis, thus linking this resistance genotype to pheromone responding plasmids...
  21. Schwaiger K, Bauer J, Hörmansdorfer S, Mölle G, Preikschat P, Kämpf P, et al. Presence of the resistance genes vanC1 and pbp5 in phenotypically vancomycin and ampicillin susceptible Enterococcus faecalis. Microb Drug Resist. 2012;18:434-9 pubmed publisher
    ..faecalis have a strong ability to acquire resistance genes-and potentially to spread them to other bacteria. Therefore, close monitoring of this species should be continued. ..
  22. Lopez M, Rezusta A, Seral C, Aspiroz C, Marne C, Aldea M, et al. Detection and characterization of a ST6 clone of vanB2-Enterococcus faecalis from three different hospitals in Spain. Eur J Clin Microbiol Infect Dis. 2012;31:257-60 pubmed publisher
    ..The inclusion of the vanB2 gene into the Tn5382 transposon was demonstrated in one isolate. Clonal dissemination of vanB2-containing the E. faecalis strain is demonstrated. ..
  23. Kim Y, Kim S, Kim Y, Lee J, Park Y, Kang M. Risk factors for vancomycin-resistant enterococci infection and mortality in colonized patients on intensive care unit admission. Am J Infect Control. 2012;40:1018-9 pubmed publisher
    ..6%) in whom VRE perianal swab cultures were obtained. Of these, 28 (11.9%) developed VRE infection. Control of infectious sources is crucial to decrease development of VRE infections and optimize the survival of VRE-colonized patients...
  24. Jansson D, Nilsson O, Lindblad J, Greko C, Bengtsson B. Inter-batch contamination and potential sources of vancomycin-resistant Enterococcus faecium on broiler farms. Br Poult Sci. 2012;53:790-9 pubmed publisher
    ..4. We conclude that VRE(fm) contaminates barns and remains present between flocks. Forklift trucks are one possible means of transmission between farms...
  25. Gardete S, Kim C, Hartmann B, Mwangi M, Roux C, Dunman P, et al. Genetic pathway in acquisition and loss of vancomycin resistance in a methicillin resistant Staphylococcus aureus (MRSA) strain of clonal type USA300. PLoS Pathog. 2012;8:e1002505 pubmed publisher an on/off switch: mutation in yvqF in strain SG-R turns on the vraSR system, which leads to increase in vancomycin resistance and down-regulation of virulence determinants...
  26. Bisicchia P, Bui N, Aldridge C, Vollmer W, Devine K. Acquisition of VanB-type vancomycin resistance by Bacillus subtilis: the impact on gene expression, cell wall composition and morphology. Mol Microbiol. 2011;81:157-78 pubmed publisher
    The vancomycin resistance operons from Enterococci, Staphylococci and Actinomycetes encode a VanRS two-component signal transduction system (TCS) and a suite of enzymes to modify the peptidoglycan biosynthetic precursor lipid II and to ..
  27. Coşkun F, Mumcuoglu I, Aksu N, Karahan Z, Us E, Tekeli F, et al. [Phenotypic and genotypic traits of vancomycin-resistant enterococci in a public hospital: the first vanB-positive Enterococcus faecium isolates]. Mikrobiyol Bul. 2012;46:276-82 pubmed
    ..This emphasized that both the diversity of VRE and the isolation rate was increasing. In order to eliminate the spread of VRE, effective surveillance studies should be performed and protective measures should be established promptly...
  28. Sood S, Malhotra M, Das B, Kapil A. Enterococcal infections & antimicrobial resistance. Indian J Med Res. 2008;128:111-21 pubmed
    ..Emergence of antimicrobial resistance, pathogenicity and virulence factors, current preventive, control and treatment modalities of severe enterococcal infections are also dealt with. ..
  29. Climo M, Sepkowitz K, Zuccotti G, Fraser V, Warren D, Perl T, et al. The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med. 2009;37:1858-65 pubmed publisher
    ..The approach is simple to implement and inexpensive and may be an important adjunctive intervention to barrier precautions to reduce acquisition of VRE and MRSA and the subsequent development of healthcare-associated BSI. ..
  30. Al Nassir W, Sethi A, Li Y, Pultz M, Riggs M, Donskey C. Both oral metronidazole and oral vancomycin promote persistent overgrowth of vancomycin-resistant enterococci during treatment of Clostridium difficile-associated disease. Antimicrob Agents Chemother. 2008;52:2403-6 pubmed publisher
    ..New CDAD treatments are needed that are less likely to disrupt the intestinal microflora and promote overgrowth of healthcare-associated pathogens. ..
  31. Ofner Agostini M, Johnston B, Simor A, Embil J, Matlow A, Mulvey M, et al. Vancomycin-resistant enterococci in Canada: results from the Canadian nosocomial infection surveillance program, 1999-2005. Infect Control Hosp Epidemiol. 2008;29:271-4 pubmed publisher
    ..Although the incidence rate of VRE carriage in Canada is increasing, it remains very low. ..
  32. Ozorowski T, Kawalec M, Zaleska M, Konopka L, Hryniewicz W. The effect of an antibiotic policy on the control of vancomycin-resistant enterococci outbreak and on the resistance patterns of bacteria isolated from the blood of patients in a hematology unit. Pol Arch Med Wewn. 2009;119:712-8 pubmed
    ..We managed to eradicate the outbreak of VRE. The introduction of antibiotic policy and enhanced infection control measures may prove efficacious in VRE control. ..
  33. Howden B, Smith D, Mansell A, Johnson P, Ward P, Stinear T, et al. Different bacterial gene expression patterns and attenuated host immune responses are associated with the evolution of low-level vancomycin resistance during persistent methicillin-resistant Staphylococcus aureus bacteraemia. BMC Microbiol. 2008;8:39 pubmed publisher
    Low-level vancomycin resistance in Staphylococcus aureus (vancomycin-intermediate S. aureus (VISA) and hetero-VISA [hVISA]) emerges during persistent infection and failed vancomycin therapy...
  34. Araújo C, Torres C, Silva N, Carneiro C, Gonçalves A, Radhouani H, et al. Vancomycin-resistant enterococci from Portuguese wastewater treatment plants. J Basic Microbiol. 2010;50:605-9 pubmed publisher
    ..faecium isolate. This study suggests that the wastewater treatment plants might be an important source of dissemination of antibiotic-resistant enterococci in Portugal. ..
  35. Chua T, Moore C, Perri M, Donabedian S, Masch W, Vager D, et al. Molecular epidemiology of methicillin-resistant Staphylococcus aureus bloodstream isolates in urban Detroit. J Clin Microbiol. 2008;46:2345-52 pubmed publisher
    ..Infection control measures should focus not only on prevention of the spread of community strains in the hospital but also prevention of the spread of hospital strains associated with VRSA into the community. ..
  36. Miller M, Bernard L, Thompson M, Grima D, Pepin J. Lack of increased colonization with vancomycin-resistant enterococci during preferential use of vancomycin for treatment during an outbreak of healthcare-associated Clostridium difficile infection. Infect Control Hosp Epidemiol. 2010;31:710-5 pubmed publisher
    ..04). Increased vancomycin use was not associated with an increase in VRE colonization over a 2-year period. Restriction of vancomycin use during CDI outbreaks because of the fear of increasing VRE colonization may not be warranted. ..
  37. Cui L, Neoh H, Shoji M, Hiramatsu K. Contribution of vraSR and graSR point mutations to vancomycin resistance in vancomycin-intermediate Staphylococcus aureus. Antimicrob Agents Chemother. 2009;53:1231-4 pubmed publisher
    ..Using a combination of Mu50Omega whole-genome sequencing and genome engineering, we observed a stepwise evolution of vancomycin resistance from VSSA to VISA after the mutated vraS and graR genes of Mu50 were engineered into Mu50Omega.
  38. Sun W, Chen H, Liu Y, Zhao C, Nichols W, Chen M, et al. Prevalence and characterization of heterogeneous vancomycin-intermediate Staphylococcus aureus isolates from 14 cities in China. Antimicrob Agents Chemother. 2009;53:3642-9 pubmed publisher
    ..8% and 22.2% were agr type 1 and agr type 2, respectively; the MIC ranges were 0.5 to 4 mg/liter for vancomycin and 0.25 to 1 mg/liter for daptomycin. ..
  39. Tsvetkova K, Marvaud J, Lambert T. Analysis of the mobilization functions of the vancomycin resistance transposon Tn1549, a member of a new family of conjugative elements. J Bacteriol. 2010;192:702-13 pubmed publisher
    Conjugative transfer from Clostridium symbiosum to enterococci of Tn1549, which confers VanB-type vancomycin resistance, has been reported. This indicates the presence of a transfer origin (oriT) in the element...
  40. Radhouani H, Pinto L, Coelho C, Sargo R, Araujo C, Lopez M, et al. MLST and a genetic study of antibiotic resistance and virulence factors in vanA-containing Enterococcus from buzzards (Buteo buteo). Lett Appl Microbiol. 2010;50:537-41 pubmed publisher
    ..faecium ST5 strain. The intestinal tract of B. buteo could be a reservoir of vanA-positive enterococci. First study focused to define the occurrence of vanA-containing Enterococcus strains in B. buteo. ..
  41. Sader H, Jones R, Rossi K, Rybak M. Occurrence of vancomycin-tolerant and heterogeneous vancomycin-intermediate strains (hVISA) among Staphylococcus aureus causing bloodstream infections in nine USA hospitals. J Antimicrob Chemother. 2009;64:1024-8 pubmed publisher
    ..6% sensitivity), indicating that the prevalence of hVISA could be higher than currently appreciated. Daptomycin was bactericidal against hVISA strains. ..
  42. Soriano A, Marco F, Martinez J, Pisos E, Almela M, Dimova V, et al. Influence of vancomycin minimum inhibitory concentration on the treatment of methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis. 2008;46:193-200 pubmed publisher
  43. Rong S, Leonard S. Heterogeneous vancomycin resistance in Staphylococcus aureus: a review of epidemiology, diagnosis, and clinical significance. Ann Pharmacother. 2010;44:844-50 pubmed publisher
    ..A uniform method of diagnosis must be established in order to better account for all cases of hGISA. More studies must be conducted to assess clinical outcomes of hGISA. ..
  44. Bourdon N, Bérenger R, Lepoultier R, Mouet A, Lesteven C, Borgey F, et al. Rapid detection of vancomycin-resistant enterococci from rectal swabs by the Cepheid Xpert vanA/vanB assay. Diagn Microbiol Infect Dis. 2010;67:291-3 pubmed publisher
    ..Compared to enriched culture, sensitivity and negative predictive value of this method were 100%. Many false-positive results were recovered (sensitivity, 85.4%; positive predictive value, 8.7%), especially for the vanB gene. ..
  45. Kurup A, Chlebicki M, Ling M, Koh T, Tan K, Lee L, et al. Control of a hospital-wide vancomycin-resistant Enterococci outbreak. Am J Infect Control. 2008;36:206-11 pubmed publisher
    ..A multipronged strategy orchestrated by a central task force curbed but could not eradicate VRE. Control measures were confounded by hospital infrastructure and high MRSA endemicity. ..
  46. Top J, Willems R, van der Velden S, Asbroek M, Bonten M. Emergence of clonal complex 17 Enterococcus faecium in The Netherlands. J Clin Microbiol. 2008;46:214-9 pubmed
    ..Infections caused by CC17 E. faecium has increased nationwide, especially in university hospitals due to the clonal spread of four MLVA types, and seems associated with acquisition of the esp gene. ..
  47. Watanabe Y, Neoh H, Cui L, Hiramatsu K. Improved antimicrobial activity of linezolid against vancomycin-intermediate Staphylococcus aureus. Antimicrob Agents Chemother. 2008;52:4207-8 pubmed publisher
  48. Ramsey A, Zilberberg M. Secular trends of hospitalization with vancomycin-resistant enterococcus infection in the United States, 2000-2006. Infect Control Hosp Epidemiol. 2009;30:184-6 pubmed publisher
    ..Because infection due to vancomycin-resistant organisms is associated with poor outcomes, the epidemiology of this trend needs further exploration. ..
  49. Arias C, Murray B. Antibiotic-resistant bugs in the 21st century--a clinical super-challenge. N Engl J Med. 2009;360:439-43 pubmed publisher
  50. Pillai S, Wennersten C, Venkataraman L, Eliopoulos G, Moellering R, Karchmer A. Development of reduced vancomycin susceptibility in methicillin-susceptible Staphylococcus aureus. Clin Infect Dis. 2009;49:1169-74 pubmed publisher
    ..Progressive vancomycin resistance correlated with increasing daptomycin nonsusceptibility...
  51. Kohlenberg A, Schwab F, Meyer E, Behnke M, Geffers C, Gastmeier P. Regional trends in multidrug-resistant infections in German intensive care units: a real-time model for epidemiological monitoring and analysis. J Hosp Infect. 2009;73:239-45 pubmed publisher
    ..This new surveillance module enables ICUs to monitor the occurrence of MDR bacteria by comparing local incidence densities with a national reference and shows significant regional variation of MDR bacteria in Germany. ..
  52. Bae I, Federspiel J, Miro J, Woods C, Park L, Rybak M, et al. Heterogeneous vancomycin-intermediate susceptibility phenotype in bloodstream methicillin-resistant Staphylococcus aureus isolates from an international cohort of patients with infective endocarditis: prevalence, genotype, and clinical significance. J Infect Dis. 2009;200:1355-66 pubmed publisher
    ..In these analyses, the hVISA phenotype occurred in more than one-quarter of MRSA IE isolates, was associated with certain IE complications, and varied in frequency by geographic region. ..
  53. Howden B, Davies J, Johnson P, Stinear T, Grayson M. Reduced vancomycin susceptibility in Staphylococcus aureus, including vancomycin-intermediate and heterogeneous vancomycin-intermediate strains: resistance mechanisms, laboratory detection, and clinical implications. Clin Microbiol Rev. 2010;23:99-139 pubmed publisher
    ..Given the subtleties of vancomycin susceptibility testing against S. aureus, it is imperative that diagnostic laboratories use well-standardized methods and have a framework for detecting reduced vancomycin susceptibility in S. aureus. ..