title: Clinical isolates of Streptococcus pneumoniae that exhibit tolerance of vancomycin.
abstract: The ability of Streptococcus pneumoniae to escape lysis and killing by vancomycin, a property termed "tolerance," has recently been noted in a laboratory strain of the species. Vancomycin tolerance in clinical isolates represents a potential new health risk. We determined the prevalence of vancomycin and penicillin tolerance among 116 clinical isolates of pneumococci by monitoring lysis and viability after exposure to the respective antibiotic for 4 hours. Eight percent of the strains were tolerant to penicillin and 3% were tolerant to vancomycin. The 3 vancomycin-tolerant isolates also had a high ratio of minimum bactericidal concentration to minimum inhibitory concentration, in contrast to nontolerant strains. They were of serotype 9V and had reduced susceptibility to penicillin. Only 1 was also tolerant to penicillin. Growth rate and ability to divide were not affected in the 3 vancomycin-tolerant strains, and they all lysed with deoxycholate, which indicates autolysin production. Vancomycin tolerance among clinical isolates of pneumococci will necessitate tracking to determine the magnitude of the evolving health risk, since tolerance may contribute to treatment failure (in particular, cases of meningitis, in which bactericidal activity is critical for eradication) and since it may also be a favored background for acquisition of resistance of vancomycin.
authors.affiliation: Department of Bacteriology, Swedish Institute for Infectious Disease Control, Microbiology and Tumor Biology Center, Karolinska Institutet, Solna, Sweden. birgitta.henriques@smi.ki.se
authors.forename: B
authors.initials: B
authors.lastname: Henriques Normark
authors.forename: R
authors.initials: R
authors.lastname: Novak
authors.forename: A
authors.initials: A
authors.lastname: Ortqvist
authors.forename: G
authors.initials: G
authors.lastname: Källenius
authors.forename: E
authors.initials: E
authors.lastname: Tuomanen
authors.forename: S
authors.initials: S
authors.lastname: Normark
mesh_terms: D000595:Amino Acid Sequence; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D004361:Drug Tolerance / Q000235:genetics; D006801:Humans; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D009238:N-Acetylmuramoyl-L-alanine Amidase / Q000378:metabolism; D010406:Penicillins / Q000494:pharmacology; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D011494:Protein Kinases / Q000737:chemistry / Q000235:genetics* / Q000378:metabolism; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification; D014640:Vancomycin / Q000494:pharmacology*; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D014640:Vancomycin; D011494:Protein Kinases; C119671:VncS histidine kinase; D009238:N-Acetylmuramoyl-L-alanine Amidase