BACKGROUND We aimed at evaluating the microbiological characteristics and clinical implication of 7 isogenic strains of Staphylococcus aureus with decreased susceptibility to vancomycin. SUBJECT AND METHOD A patient with nosocomial trival vularendocarditis due to methicillin-resistant S. aureus had positive blood cultures for 8 weeks despite antimicrobial therapy with vancomycin (normal serum levels) and rifampicin. The patient rejected surgical treatment but the process cured with antimicrobial therapy. The epidemiological relationship of strains was evaluated by pulsed field gel electrophoresis. The susceptibility to vancomycin was evaluated by microdilution and E-test using two different in ocula. The activity of oxacillin, ampicillin and cephalotin was evaluated in Mueller Hinton (MH) agar containing different concentrations of vancomycin (0.06 to 4 mg/l). Heteroresistant subpopulations were determined in both MH and brain heart infussion agar containing vancomycin (0.5 to 512 mg/l). All seven strains belonged to the same clone. Vancomycin MIC ranged from 1 mg/l (isolates 1 to 5) to 4 mg/l (isolates 6 and 7). Isolates 6 and 7 displayed differences in pigmentation and slower growth rates. The susceptibility of these isolates to betalactams inMH containing different concentrations of vancomycin was greater than that in controls. Subpopulations heteroresistant to vancomycin were not detected. CONCLUSION The decreased susceptibility of the isogenic S. aureus strains evaluated in this study was not due to heteroresistance and did not cause therapeutic failure.