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Glycopeptide tolerance in bacteria causing endocarditis.

J D Perry¹, A L Jones, F K Gould

¹Department of Microbiology, Freeman Hospital, Newcastle upon Tyne, UK. homeresearch@compuserve.com

The Journal of Antimicrobial Chemotherapy

|August 25, 1999

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Glycopeptides like vancomycin are used for endocarditis, but tolerance is common in bacteria. This means bactericidal activity may not be predicted, suggesting combination therapy might be needed.

Area of Science:

Microbiology
Infectious Diseases
Pharmacology

Background:

Glycopeptides are recommended treatments for bacterial endocarditis.
Understanding the activity of these agents against common pathogens is crucial.

Purpose of the Study:

To compare the Minimum Inhibitory Concentrations (MICs) and Minimum Bactericidal Concentrations (MBCs) of vancomycin and teicoplanin.
To assess the prevalence of tolerance to these glycopeptides in bacterial endocarditis isolates.

Main Methods:

Collected 100 bacterial isolates from patients with confirmed endocarditis.
Determined MICs and MBCs for vancomycin and teicoplanin.
Evaluated bacterial tolerance to both glycopeptide agents.

Main Results:

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Teicoplanin generally exhibited lower MICs compared to vancomycin.
Bacterial tolerance to both vancomycin and teicoplanin was frequently observed across Enterococci, Streptococci, and Staphylococci species.
Specifically, 78% of Streptococci and 57% of Staphylococci isolates showed tolerance to teicoplanin and vancomycin, respectively.

Conclusions:

Despite appearing sensitive based on MICs, the bactericidal activity of glycopeptides in endocarditis treatment cannot always be reliably predicted.
For endocarditis cases requiring glycopeptide therapy, consider combination treatment with an aminoglycoside, especially if MBC testing is not feasible.