title: Importance of penicillinase production for activity of penicillin alone or in combination with sulbactam in experimental endocarditis due to methicillin-resistant Staphylococcus aureus.
abstract: The activity of penicillin, alone and in combination with sulbactam, against a heterogeneously methicillin-resistant, penicillinase-producing clinical isolate of Staphylococcus aureus and its penicillinase-negative derivative was investigated in vitro and in a rabbit experimental endocarditis model. Penicillin was significantly more effective than vancomycin against the penicillinase-negative derivative in vivo (P < 0.001), and it sterilized 25% of the vegetations. The combination of penicillin and sulbactam exhibited an in vivo synergistic effect on the penicillinase-producing strain (P < 0.01) but did not produce any advantage over treatment with vancomycin, even when a high dose of sulbactam was used (100 mg/kg of body weight every 6 h). This combination was significantly less effective against the penicillinase-producing strain than was penicillin alone against the penicillinase-negative derivative (P < 0.03). In addition, the most resistant subpopulation of the surviving bacteria, which grew on agar containing 16 micrograms of methicillin per ml, was detected in 5 of 6 animals treated with penicillin and a high dose of sulbactam against the penicillinase-producing strain compared with only 1 of 12 animals treated with penicillin alone against the penicillinase-negative derivative (P < 0.01). We conclude that penicillin is highly effective against penicillinase-negative methicillin-resistant S. aureus and that penicillinase production, rather than methicillin resistance, appears to be the limiting factor for the activity of the penicillin-sulbactam combination against penicillinase-producing, methicillin-resistant S. aureus.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, Unité 13, Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Fantin
authors.forename: J
authors.initials: J
authors.lastname: Pierre
authors.forename: N
authors.initials: N
authors.lastname: Castéla-Papin
authors.forename: L
authors.initials: L
authors.lastname: Saint-Julien
authors.forename: H
authors.initials: H
authors.lastname: Drugeon
authors.forename: R
authors.initials: R
authors.lastname: Farinotti
authors.forename: C
authors.initials: C
authors.lastname: Carbon
mesh_terms: D000818:Animals; D004357:Drug Synergism; D004359:Drug Therapy, Combination / Q000494:pharmacology / Q000627:therapeutic use*; D004696:Endocarditis / Q000188:drug therapy*; D005260:Female; D016106:Methicillin Resistance; D010405:Penicillinase / Q000096:biosynthesis*; D010406:Penicillins / Q000494:pharmacology / Q000627:therapeutic use; D011817:Rabbits; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D013407:Sulbactam / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D010406:Penicillins; D010405:Penicillinase; D013407:Sulbactam