Affiliation:
1. Division of Infectious Diseases, San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California 94143
Abstract
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 μg/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.
Publisher
American Society for Microbiology
Subject
Infectious Diseases,Pharmacology (medical),Pharmacology
Cited by
134 articles.
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