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Glycopeptide tolerance in Staphylococcus aureus

J May¹, K Shannon, A King

¹Department of Microbiology, UMDS, St Thomas' Hospital, London, UK.

The Journal of Antimicrobial Chemotherapy

|September 17, 1998

Summary

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Glycopeptide tolerance in Staphylococcus aureus, particularly methicillin-resistant strains (MRSA), is a real concern. This tolerance can hinder vancomycin treatment effectiveness in serious infections.

Area of Science:

Microbiology
Infectious Diseases
Pharmacology

Background:

Vancomycin treatment failures in Staphylococcus aureus infections have raised concerns about antimicrobial tolerance.
Glycopeptide tolerance, a state where bacteria are not killed by antibiotics at standard concentrations, requires further investigation.

Purpose of the Study:

To investigate glycopeptide tolerance in clinical isolates of Staphylococcus aureus.
To assess tolerance to vancomycin and teicoplanin in isolates from patients with endocarditis or bacteremia.

Main Methods:

Determined Minimum Bactericidal Concentration (MBC)/Minimum Inhibitory Concentration (MIC) ratios.
Utilized time-kill assays with vancomycin (20 mg/L) over 6 hours.
Analyzed 35 clinical isolates of Staphylococcus aureus, including methicillin-resistant (MRSA) and methicillin-susceptible strains.

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Main Results:

Vancomycin tolerance was observed in Staphylococcus aureus isolates, with good agreement between MBC:MIC ratios and time-kill assays.
Time-kill assays identified tolerance in 7 of 15 MRSA isolates versus 2 of 20 methicillin-susceptible isolates (P=0.04).
Tolerance was more frequent in isolates from endocarditis patients (7/16) compared to other conditions (2/19), and often co-occurred with teicoplanin tolerance.

Conclusions:

Glycopeptide tolerance is a significant phenomenon in Staphylococcus aureus, especially in MRSA.
Time-kill analysis provides a reliable method for determining glycopeptide tolerance.
Antibiotic tolerance in Staphylococcus aureus may compromise glycopeptide therapy efficacy and warrants consideration in treatment decisions.