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PMID: 12654656 Published · ppublish English Case Reports Journal Article Research Support, U.S. Gov't, P.H.S.

Vancomycin treatment failure associated with heterogeneous vancomycin-intermediate Staphylococcus aureus in a patient with endocarditis and in the rabbit model of endocarditis.

Antimicrobial agents and chemotherapy ·Vol. 47 ·No. 4 ·2003-04-00 ·Pages 1262-6

Moore MR, Perdreau-Remington F, Chambers HF

Abstract

Heterogeneous resistance to vancomycin is thought to precede emergence of intermediate susceptibility to vancomycin in Staphylococcus aureus, but the clinical significance of heterogeneous resistance is unknown. Paired S. aureus isolates from a patient with endocarditis who relapsed after vancomycin treatment were tested for heterogeneous resistance to vancomycin. The pretreatment and the relapse clinical isolates (strains SF1 and SF2, respectively) were genotyped by pulsed-field gel electrophoresis. Susceptibility to vancomycin was assessed by the broth dilution method, population analysis, and time-kill studies and in the rabbit model of endocarditis. Strains SF1 and SF2 had similar genotypes, and the vancomycin MICs for the strains were </=2 micro g/ml. SF2 exhibited heterogeneous resistance to vancomycin. Vancomycin eradicated SF1 in the rabbit model of endocarditis, while SF2 persisted at pretreatment levels. Vancomycin treatment failure in this patient with endocarditis was attributable to heterogeneous resistance to vancomycin.

MeSH Terms
Animals Disease Models, Animal Drug Resistance, Bacterial Endocarditis, Bacterial/drug therapy Humans Male Middle Aged Rabbits Staphylococcal Infections/drug therapy Treatment Failure Vancomycin/therapeutic use
Chemicals
Vancomycin
Authors & Affiliations
3 authors, click to expand affiliations / ORCID
Moore Matthew R
Division of Infectious Diseases, San Francisco General Hospital, California, USA. [email protected]
Perdreau-Remington Françoise
Chambers Henry F
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Article Info
Journal
Antimicrobial agents and chemotherapy
Abbr.
Antimicrob Agents Chemother
ISSN
0066-4804
DOI
10.1128/AAC.47.4.1262-1266.2003
Email
[email protected]
Published
2003-04-00
Pages
1262-6
Language
English
Region
United States
NLM ID
0315061
PMCID
PMC152514
Subset
IM
Grants
NIAID NIH HHS · AI43959 · United States
External Links
PubMed source DOI: 10.1128/AAC.47.4.1262-1266.2003 PMC Full Text View journal details
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