The in vitro activity of vancomycin and combinations of vancomycin-gentamicin and vancomycin-streptomycin against enterococci was investigated. The minimal inhibitory concentration of vancomycin for 99 of 100 enterococcal strains isolated clinically was 3.12 ,ug or less/ml. When cultures of eight strains were incubated with vancomycin, regardless of the inoculum size (106, 105, or 104) and concentration of vancomycin (10 or 20 qg/ml), there was no significant reduction in the number of viable enterococci at 6, 24, and 48 h. Gentamicin and streptomycin in concentrations attainable clinically were not effective against enterococci. Vancomycin combined with gentamicin or streptomycin was tested against 41 enterococcal strains. With the combination of vancomycin at 10 ,g/ml and gentamicin at 4 ,g/ml or vancomycin at 5 Ag/ml and gentamicin at 4 ug/ml, synergism was demonstrated against all 41 strains at 6 h.
Endocarditis was induced in the rabbit by the placement of a polyethylene catheter in the right heart. The catheter was filled with stable L-phase variants of Staphylococcus aureus to determine if the variant form would colonize the damaged endocardium and produce further tissue injury similar to that produced by the vegetative bacterial phase. No L-phase variants were recovered from cultures of blood or vegetations, although pure cultures of L-phase variants were obtained from all catheters, including one in place for 70 days. The vegetations were grossly similar in control animals with sterile media in the catheters and animals with catheters containing L-phase variants, although polymorphonuclear leukocytes and eosinophils were more frequently found in vegetations from animals inoculated with L-phase variants. Endocarditis was also induced in animals with vegetative S. aureus and then treated with penicillin G. Blood cultures in hypertonic media often grew vegetative S. aureus when there was no growth in routine media, but no L-phase variants were detected. Vegetative S. aureus, but not wall-defective variants, were isolated from vegetations of all treated animals. on August 1, 2020 by guest http://iai.asm.org/ Downloaded from 726 INFECT. IMMUNITY on August 1, 2020 by guest http://iai.asm.org/ Downloaded from
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