title: Successful therapy of experimental chronic foreign-body infection due to methicillin-resistant Staphylococcus aureus by antimicrobial combinations.
abstract: We compared the efficacy of a long-duration (3-week) therapy of vancomycin, fleroxacin, fleroxacin plus rifampin, and vancomycin plus fleroxacin and rifampin in a recently developed rat model of chronic staphylococcal foreign-body infection. Subcutaneous tissue cages containing polymethylmethacrylate coverslips were infected with 1 x 10(5) to 5 x 10(5) CFU of methicillin-resistant Staphylococcus aureus. Three weeks later, a quantitative culturing of the fluid that had accumulated in the cages was done (mean, 6.72 log10 CFU/ml; n = 110) and treatment was initiated after randomization. The CFUs in the cage fluid were counted on days 11 and 22 and 1 week after the termination of treatment; in addition, a final culture of coverslips (surface-bound microorganisms) was performed. The three-drug therapy was significantly superior to the other treatments on day 11 (a 5.16 log10 decrease of bacterial counts versus a 2.12 log10 to 2.94 log10 decrease for vancomycin, fleroxacin, and fleroxacin plus rifampin; P less than 0.01). On day 22, count decreases were 4.16 log10 for vancomycin, 4.91 log10 for fleroxacin (vancomycin versus fleroxacin, not significant), 6.14 log10 for two-drug therapy, and 6.34 log10 for three-drug therapy (vancomycin-fleroxacin-rifampin versus fleroxacin-rifampin, not significant; fleroxacin-rifampin versus monotherapies, P less than 0.01); the numbers of CFU in most cage fluids were under the detection limit (20 CFU/ml) in combination groups. One week after the end of treatment, 92% of fluids and coverslips (detection limit, 1 CFU) were culture negative with tritherapy, 88% of fluids and 41% of coverslips were negative with bitherapy, and less than 12% of fluids and coverslips were negative with single drugs (for coverslips, P was <0.01 for vancomycin-fleroxacin-rifampin versus fleroxacin-rifampin and P was <0.001 for fleroxacin-rifampin versus the monotherapies). No mutants resistant to rifampin or fleroxacin were detected. In conclusion, antimicrobial combinations were highly effective and superior to single drugs in treating a chronic staphylococcal foreign-body infection for 3 weeks. The three-drug therapy decreased bacterial counts more rapidly than the two-drug therapy under study and appeared to be curative in most cases.
authors.affiliation: Division of Infectious Diseases, University Hospital, Geneva, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Chuard
authors.forename: M
authors.initials: M
authors.lastname: Herrmann
authors.forename: P
authors.initials: P
authors.lastname: Vaudaux
authors.forename: F A
authors.initials: FA
authors.lastname: Waldvogel
authors.forename: D P
authors.initials: DP
authors.lastname: Lew
mesh_terms: D000818:Animals; D002478:Cells, Cultured; D002908:Chronic Disease; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D016576:Fleroxacin / Q000008:administration & dosage / Q000627:therapeutic use*; D005549:Foreign-Body Reaction / Q000188:drug therapy*; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D051381:Rats; D011919:Rats, Inbred Strains; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects*; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014640:Vancomycin; D016576:Fleroxacin; D012293:Rifampin