title: In vitro activities of cefotaxime, vancomycin, quinupristin/dalfopristin, linezolid and other antibiotics alone and in combination against Propionibacterium acnes isolates from central nervous system infections.
abstract: OBJECTIVE
  To evaluate the antibiotic susceptibilities of Propionibacterium acnes isolates from central nervous system (CNS) infections to agents used in current treatment regimens.
  
  
  METHODS
  MICs of 16 reference antibiotics were determined by an agar dilution method for 24 consecutive strains of P. acnes isolated from individual patients with intracranial empyema or brain abscess. Bactericidal activities of antibiotics against P. acnes PAN14 were studied at 0.25-2 x MIC using a time-kill method.
  
  
  RESULTS
  All of the isolates were resistant to fosfomycin, intermediate or resistant to metronidazole and susceptible to all the other antibiotics tested, except for nine strains, which were intermediate to ofloxacin. Among antibiotics tested alone in time-kill experiments, vancomycin was the most effective drug and exhibited bactericidal activity after 24 h at 1x and 2 x MIC, whereas cefotaxime and ciprofloxacin were bactericidal after 48 h at 2 x MIC. No significant bactericidal activity could be demonstrated with the other antibiotics tested alone. The addition of cefotaxime to vancomycin resulted in bactericidal activity at lower concentrations (0.5 x MIC), whereas synergy was observed between quinupristin/dalfopristin and cefotaxime at 2 x MIC. In contrast, antagonism was observed between cefotaxime and linezolid, and ciprofloxacin and clindamycin.
  
  
  CONCLUSIONS
  Our data suggest that P. acnes isolates causing CNS infections remain highly susceptible to most antibiotics used for the treatment of such infections. Moreover, we showed that cefotaxime, vancomycin and ciprofloxacin possess good bactericidal activities against P. acnes, and that these activities may be enhanced when vancomycin is combined with cefotaxime or when cefotaxime is combined with quinupristin/dalfopristin.
authors.affiliation: Laboratoire de Bactériologie-Virologie, UMR-CNRS 7565, Faculté de Médecine, 54500 Vandoeuvre-les-Nancy, France.
authors.forename: Francine
authors.initials: F
authors.lastname: Mory
authors.forename: Sébastien
authors.initials: S
authors.lastname: Fougnot
authors.forename: Christian
authors.initials: C
authors.lastname: Rabaud
authors.forename: Hélène
authors.initials: H
authors.lastname: Schuhmacher
authors.forename: Alain
authors.initials: A
authors.lastname: Lozniewski
mesh_terms: D000081:Acetamides / Q000008:administration & dosage; D002439:Cefotaxime / Q000008:administration & dosage; D002494:Central Nervous System Infections / Q000188:drug therapy* / Q000382:microbiology*; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D000069349:Linezolid; D008826:Microbial Sensitivity Tests; D023303:Oxazolidinones / Q000008:administration & dosage; D011425:Propionibacterium acnes / Q000187:drug effects* / Q000502:physiology; D014640:Vancomycin / Q000008:administration & dosage; D014769:Virginiamycin / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000081:Acetamides; D023303:Oxazolidinones; D014769:Virginiamycin; C113825:quinupristin; D014640:Vancomycin; D000069349:Linezolid; D002439:Cefotaxime; C113826:dalfopristin