Constitutively vancomycin-resistant Enterococcus faecium resistant to synergistic beta-lactam combinations

Michael Green; Brian Binczewski; A William Pasculle; Michael Edmund; Karen Barbadora; Shimon Kusne; David M Shlaes

doi:10.1128/AAC.37.6.1238

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Constitutively vancomycin-resistant Enterococcus faecium resistant to synergistic beta-lactam combinations

Journal article

Open access

Peer reviewed

Constitutively vancomycin-resistant Enterococcus faecium resistant to synergistic beta-lactam combinations

Michael Green, Brian Binczewski, A William Pasculle, Michael Edmund, Karen Barbadora, Shimon Kusne and David M Shlaes

Antimicrobial agents and chemotherapy, Vol.37(6), pp.1238-1242

06/1993

DOI: 10.1128/AAC.37.6.1238

PMCID: PMC187946

PMID: 8328775

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Abstract

Vancomycin resistance among enterococci has recently been recognized. Synergy between vancomycin and penicillin has been shown in vitro for isolates of Enterococcus faecium resistant to both of these antibiotics. We describe three isolates of vancomycin-resistant E. faecium which demonstrate unique phenotypic characteristics. The isolates exhibited high-level resistance to both vancomycin and teicoplanin, consistent with the VanA phenotype. However, resistance in these isolates could not be induced or cured, and mating experiments failed to detect a transfer of resistance. The combination of vancomycin and penicillin did not significantly change the MIC of penicillin for any of the three isolates. Immunoblotting with polyclonal anti-VanB antibody showed no reaction with the cellular proteins of these strains. Probing with a vanA oligonucleotide revealed hybridization with chromosomal but not plasmid DNA. The mechanism of constitutive resistance of those strains remains unclear. A second mutational change, perhaps involving PBP 5, may explain the presence of resistance to synergistic combination penicillin-vancomycin therapy. In vitro evaluation of penicillin-vancomycin should be carried out in all clinical cases where this therapeutic regimen is being considered.

Phenotype

DNA Probes

Enterococcus faecium - drug effects

Enterococcus faecium - physiology

Humans

Molecular Sequence Data

Immunoblotting

Enterococcus faecium - genetics

beta-Lactams

Drug Therapy, Combination - pharmacology

Drug Synergism

Microbial Sensitivity Tests

Drug Resistance, Microbial

Novobiocin - pharmacology

Base Sequence

Vancomycin - pharmacology

Adult

Anti-Bacterial Agents - pharmacology

Penicillins - pharmacology

Details

Title: Subtitle: Constitutively vancomycin-resistant Enterococcus faecium resistant to synergistic beta-lactam combinations
Creators: Michael Green - Department of Medicine, Children's Hospital of Pittsburgh, Pennsylvania
Brian Binczewski
A William Pasculle
Michael Edmund
Karen Barbadora
Shimon Kusne
David M Shlaes
Resource Type: Journal article
Publication Details: Antimicrobial agents and chemotherapy, Vol.37(6), pp.1238-1242
Publisher: American Society for Microbiology ; United States
DOI: 10.1128/AAC.37.6.1238
PMID: 8328775
PMCID: PMC187946
ISSN: 0066-4804
eISSN: 1098-6596
Grant note: RR00084 / NCRR NIH HHS
Language: English
Date published: 06/1993
Academic Unit: Infectious Diseases; Internal Medicine
Record Identifier: 9983905644702771

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