[In vitro combination effect of vancomycin and carbapenems against carbapenem-resistant MRSA]

We determined in vitro combined effects of vancomycin (VCM) plus carbapenems (CRBs) on 12 methicillin-resistant Staphylococcus aureus (MRSA) which are resistant to CRBs. Combinations of VCM plus imipenem (IPM) and VCM plus panipenem (PAPM) and VCM plus meropenem (MEPM) indicated synergistic effects, fractional inhibitory concentration (FIC) indices of < or = 0.05, against 67%, 75%, 67% of the strains, respectively. Against forty two percent of strains tested, 1 MIC of VCM was equal to 1 MBC, and similarly, IPM, PAPM and MEPM had 1 MIC = 1 MBC against 42%, 67% and 75% of the strains tested, respectively. Combinations of VCM plus IPM and VCM plus PAPM and VCM plus MEPM showed synergistic effects, hence a fractional bactericidal concentration (FBC) index of < or = 0.50, against 42%, 50%, 75% of the strains, respectively, and the combination of VCM plus MEPM was most synergistic. These results suggest that combination therapy of VCM with CRB is useful for the treatment of MRSA infection in patients with renal dysfunction.