Abstract
identification of the detection of resistant mutants. With the appearance of the latter, daptomycin minimal inhibitory concentrations (MICs) rose, along with those of vancomycin, and this was accompanied by thickened cell walls and reduced autolysis, decreased surface anionic charge, and susceptibility to cationic peptides. Whole-genome sequencing demonstrated that the vancomycinintermediate S. aureus (VISA) phenotype was acquired via at least 3 different genetic pathways and that, in one of the 2 cases, the pathway differed from that seen in vivo. High-level resistance of S. aureus to vancomycin, resulting from horizontal
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