The influence of pretreatment of Escherichia coi and Staphylococcus aureus with sub-MICs of the new P-lactam antibiotic imipenem on phagocytosis and kffling by murine peritoneal macrophages and the susceptibility of these organisms to serum bactericidal activity were studied. The effects of imipenem, a round form inducer in gram-negative rods, and piperacillin, a filamentous form inducer, were compared. Bacteria grown in the presence of sub-MICs of imipenem or piperacillin were incubated for 30 min with macrophage monolayers in the absence of antibiotic. Phagocytosis, killing, and survival within macrophages were evaluated by microbiological and fluorescence microscope assays. Bacteria grown in the presence of a sub-MIC of imipenem were phagocytized and killed in numbers significantly higher than untreated or piperacillin-treated bacteria were. Intracellular bacteria pretreated with a sub-MIC of imipenem were also readily killed by lymphokine-activated macrophages. Prior treatment with a sub-MIC of imipenem resulted in an increased susceptibility ofE. coli but not S. aureus to the bactericidal activity of immune serum. Imipenem treatment and immune serum acted synergistically to enhance phagocytosis and killing. The data indicate that exposure of E. coli and S. aureus to a sub-MIC of imipenem enhances the susceptibility of these potential pathogens to cellular and humoral host defense mechanisms.The activity of antibiotics against clinically significant bacteria is usually expressed in terms of concentrations that either inhibit growth or kill microorganisms in vitro. Concentrations of antibiotics which are less than the MIC are defined as sub-MICs (18). Evidence is accumulating that antibiotics may be beneficial to infected hosts even when present at sub-MICs (8,15,23). This effect appears to be independent of the bactericidal potential of the antibiotic but is related to structural or metabolic changes which augment the susceptibility of bacterial pathogens to humoral and cellular defenses. Therefore, antibiotics at sub-MICs that act in concert with host defenses may be clinically significant.We undertook this study to determine whether pretreatment of Escherichia coli and Staphylococcus aureus with sub-MICs of imipenem altered their susceptibility either to serum bactericidal activity or to phagocytosis and killing by murine macrophages. Imipenem, a P-lactam antibiotic and member of a new class, the carbapenems, is the first clinically available derivative of thienamycin (11). Imipenem possesses an unusually broad antibacterial spectrum, is biologically active at extremely low concentrations, and exhibits no cross resistance with other P-lactam antibiotics (13). Comparative studies indicate that there is a greater potency and wider spectrum of activity for imipenem than for other P-lactams against both gram-positive and gramnegative species (12). Another interesting attribute of imipenem is that at sub-MICs, the drug fails to induce the filamentation of gram-negative bacteria, as is the case with other penici...