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Mechanisms of S. aureus resistance to vancomycin: VISA strains. VISA strains appear to be selected from isolates that are heterogeneously resistant to vancomycin. These VISA strains synthesize additional quantities of peptidoglycan with an increased number of D-Ala-D-Ala residues that bind vancomycin, preventing the molecule from getting to its bacterial target. Adapted from ref. 98.
