Vancomycin Heteroresistance and Methicillin-ResistantStaphylococcus aureus

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Abstract
Heteroresistance refers to the presence, within a larger population of fully antimicrobial-susceptible microorganisms, of subpopulations with lesser susceptibility. This phenomenon has been described in a wide range of microorganisms, but much recent attention has been directed toward its expression in Staphylococcus aureus . Although it has long been known that resistance to methicillin is characteristically heterogeneously expressed by this organism [ 1 ], the current focus revolves around its heteroresistance to vancomycin. Heteroresistant subpopulations of vancomycin-susceptible S. aureus (hVISA) were first described in 1997 [ 2 ], shortly after the initial description of vancomycin intermediately susceptible strains (VISA) [ 3 ]. hVISA have minimum inhibitory concentrations (MICs) in the intermediately susceptible range and likely represent a step on the path to the development of a fully VISA population

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