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Antimicrobial Agents and Chemotherapy, September 2009, p. 3880-3886, Vol. 53, No. 9
0066-4804/09/$08.00+0 doi:10.1128/AAC.00134-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
Activities of Daptomycin and Vancomycin Alone and in Combination with Rifampin and Gentamicin against Biofilm-Forming Methicillin-Resistant Staphylococcus aureus Isolates in an Experimental Model of Endocarditis 
University of Rhode Island, Department of Pharmacy Practice,1 Infectious Diseases Research Laboratory, Providence Veterans Affairs Medical Center,2 Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island3
Received 29 January 2009/ Returned for modification 9 April 2009/ Accepted 20 June 2009
The findings of clinical and in vitro research support the theory that infective endocarditis (IE)-causing bacteria form biofilms and that biofilms negatively affect treatment outcomes. The purpose of the present study was to quantify the biofilm formation of methicillin (meticillin)-resistant Staphylococcus aureus (MRSA) isolates obtained from patients with IE and to evaluate the in vitro activities of daptomycin and vancomycin alone and in combination with rifampin (rifampicin) or gentamicin while monitoring the isolates for the development of resistance. A high-inoculum, stationary-phase infection model of IE was used to simulate the pharmacokinetics in humans of daptomycin at 6 mg/kg of body weight/day, vancomycin at 1.25 g every 12 h (q12h) alone and in combination with rifampin at 300 mg every 8 h, and gentamicin at 1.3 mg/kg q12h. Two randomly selected clinical MRSA isolates were obtained from patients with IE; both MRSA isolates quantitatively produced biofilms. The time to bactericidal activity in the presence of daptomycin was isolate dependent but was achieved by 24 h for both MRSA isolates. Vancomycin did not achieve bactericidal activity throughout the experiment. At 24, 48, and 72 h, daptomycin-containing regimens had significantly more activity (greater declines in the mean number of CFU/g) than any of the vancomycin-containing regimens (P = 0.03). Rifampin and gentamicin antagonized or delayed the bactericidal activity of daptomycin (against MRSA B346846 for rifampin and against both isolates for gentamicin) in the first 24 h. Increases in the daptomycin and vancomycin MICs were not observed. We conclude that in an IE model of biofilm-forming MRSA, daptomycin monotherapy has better in vitro activity than daptomycin in combination with rifampin or gentamicin or any vancomycin-containing regimen studied within the first 24 h. Further investigations are needed to understand the initial delay in bactericidal activity observed when gentamicin or rifampin is combined with daptomycin.
* Corresponding author. Mailing address: University of Rhode Island, Veterans Affairs Medical Center (151), Research Building, 830 Chalkstone Avenue, Providence, RI 02908. Phone: (401) 273-7100, ext. 2339. Fax: (401) 457-3305. E-mail: KerryTedesco{at}uri.edu
Published ahead of print on 29 June 2009.
Antimicrobial Agents and Chemotherapy, September 2009, p. 3880-3886, Vol. 53, No. 9
0066-4804/09/$08.00+0 doi:10.1128/AAC.00134-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
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