False synergy between vancomycin and beta-lactams against glycopeptide-intermediate Staphylococcus aureus (GISA) caused by inappropriate testing methods

Clin Microbiol Infect. 2004 Apr;10(4):342-5. doi: 10.1111/j.1198-743X.2004.00856.x.

Abstract

The combination of vancomycin and beta-lactams is often considered synergistic and has been recommended for the treatment of glycopeptide-intermediate Staphylococcus aureus (GISA) infections. In this study, the combination of vancomycin or teicoplanin with different beta-lactams was tested. When using NaCl 4% w/v, for better expression of heterogeneous resistance to beta-lactams, with a longer (48-h) incubation period and a higher (10(7) CFU/mL) inoculum, the association of vancomycin with beta-lactams was antagonistic. However, a synergistic effect was observed for teicoplanin under the same conditions.

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Drug Synergism
  • False Positive Reactions
  • Humans
  • Microbial Sensitivity Tests / methods
  • Staphylococcus aureus / drug effects*
  • Teicoplanin / pharmacology*
  • Vancomycin / pharmacology*
  • beta-Lactams / pharmacology*

Substances

  • Anti-Bacterial Agents
  • beta-Lactams
  • Teicoplanin
  • Vancomycin