Diagnostic value of BHI-V4 for heterogeneous and vancomycin-intermediate Staphylococcus aureus isolates: a systematic review and meta-analysis

BMC Infect Dis. 2024 May 14;24(1):494. doi: 10.1186/s12879-024-09274-4.


Background: Brain-heart infusion agar supplemented with 4 µg/mL of vancomycin (BHI-V4) was commonly used for the detection of heterogeneous (hVISA) and vancomycin-intermediate Staphylococcus aureus (VISA). However, its diagnostic value remains unclear. This study aims to compare the diagnostic accuracy of BHI-V4 with population analysis profiling with area under the curve (PAP-AUC) in hVISA/VISA.

Methods: The protocol of this study was registered in INPLASY (INPLASY2023120069). The PubMed and Cochrane Library databases were searched from inception to October 2023. Review Manager 5.4 was used for data visualization in the quality assessment, and STATA17.0 (MP) was used for statistical analysis.

Results: In total, eight publications including 2153 strains were incorporated into the meta-analysis. Significant heterogeneity was evident although a threshold effect was not detected across the eight studies. The summary receiver operating characteristic (SROC) was 0.77 (95% confidence interval [CI], 0.74-0.81). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic score and diagnostic odds ratio were 0.59 (95% CI: 0.46-0.71), 0.96 (95%CI: 0.83-0.99), 14.0 (95% CI, 3.4-57.1), 0.43 (95%CI, 0.32-0.57), 3.48(95%CI, 2.12-4.85) and 32.62 (95%CI, 8.31-128.36), respectively.

Conclusion: Our study showed that BHI-V4 had moderate diagnostic accuracy for diagnosing hVISA/VISA. However, more high-quality studies are needed to assess the clinical utility of BHI-V4.

Keywords: BHI-V4; Diagnostic value; Meta-analysis; Systematic review; VISA; hVISA.

Publication types

  • Systematic Review
  • Meta-Analysis

MeSH terms

  • Anti-Bacterial Agents* / pharmacology
  • Area Under Curve
  • Culture Media
  • Humans
  • Microbial Sensitivity Tests*
  • Sensitivity and Specificity
  • Staphylococcal Infections* / diagnosis
  • Staphylococcal Infections* / microbiology
  • Staphylococcus aureus* / drug effects
  • Staphylococcus aureus* / isolation & purification
  • Vancomycin Resistance
  • Vancomycin* / pharmacology