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Antimicrobial Agents and Chemotherapy, November 2000, p. 3055-3060, Vol. 44, No. 11
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

In Vitro Synergistic Effects of Double and Triple Combinations of beta -Lactams, Vancomycin, and Netilmicin against Methicillin-Resistant Staphylococcus aureus Strains

Stéphanie Rochon-Edouard, Martine Pestel-Caron,* Jean-François Lemeland, and François Caron

Groupe de Recherche sur les Antimicrobiens et les Micro-organismes (GRAM, EA 2656), 76031 Rouen, France

Received 2 March 2000/Returned for modification 1 July 2000/Accepted 24 August 2000

Several studies have previously reported synergistic effects between vancomycin and a given beta -lactam or a given aminoglycoside against methicillin-resistant Staphylococcus aureus (MRSA) strains. The aim of our study was to exhaustively compare the effects of different combinations of a beta -lactam, vancomycin, and/or an aminoglycoside against 32 clinical MRSA strains with different aminoglycoside susceptibility patterns. The effects of 26 different beta -lactam-vancomycin and 8 different aminoglycoside-vancomycin combinations were first studied using a disk diffusion screening method. The best interactions with vancomycin were observed with either imipenem, cefazolin, or netilmicin. By checkerboard studies, imipenem-vancomycin and cefazolin-vancomycin each provided a synergistic bacteriostatic effect against 22 strains; the mean fractional inhibitory concentration (FIC) indexes were 0.35 and 0.46 for imipenem-vancomycin and cefazolin-vancomycin, respectively. The vancomycin-netilmicin combination provided an indifferent effect against all of the 32 strains tested; the mean of FIC index was 1.096. The mean concentrations of imipenem, cefazolin, netilmicin, and vancomycin at which FIC indexes were calculated were clinically achievable. Killing experiments were then performed using imipenem, cefazolin, netilmicin, and vancomycin at one-half of the MIC, alone and in different combinations, against 10 strains. The vancomycin-netilmicin regimen was rarely bactericidal, even against strains susceptible to netilmicin. The imipenem-vancomycin and cefazolin-vancomycin combinations were strongly bactericidal against six and five strains, respectively. The addition of netilmicin markedly enhanced the killing activity of the combination of cefazolin or imipenem plus vancomycin, but only for the MRSA strains against which the beta -lactam-vancomycin combinations had no bactericidal effect. It is noteworthy that the latter strains were both susceptible to netilmicin and heterogeneously resistant to methicillin.

* Corresponding author. Mailing address: Laboratoire de Bactériologie, Centre Hospitalier Universitaire Charles Nicolle, 76031 Rouen Cedex, France. Phone: 33 2 32 88 80 52. Fax: 33 2 32 88 80 24. E-mail: Martine.Pestel-Caron{at}chu-rouen.fr.

Antimicrobial Agents and Chemotherapy, November 2000, p. 3055-3060, Vol. 44, No. 11
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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