PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Enterococcus faecium”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,045 records · Page 58Linked to original sources

Inhibition effect of enterocin CCM 4231 in the rumen fluid environment.

Enterocin CCM 4231 is a bacteriocin with a broad antimicrobial spectrum produced by the ruminal strain Enterococcus faecium CCM 4231. Its inhibitory effect towards enterococci, Ent. faecium EF 26/42, staphylococci, Streptococcus bovis AO 24/85 and Escherichia coli, as well as towards Listeria monocytogenes OHIO strain, in the rumen fluid environment was studied during culture at 37 and 30 degrees C for 24 h and 20 days. Enterocin CCM 4231 was added to the samples at a concentration of 3200 AU ml-1. The best inhibitory effect was noted against enterococci at both cultivation temperatures. A decrease in total cell count from 10(8) cfu ml-1/or 10(4) cfu ml-1 and from 10(5) cfu ml-1 to 10(1) cfu ml-1 was detected. Addition of enterocin to the rumen fluid also inhibited staphylococci (from 10(5) cfu ml-1 to 10(4) cfu ml-1 and/or 10(3) cfu ml-1). Gram-negative E. coli cells were inhibited at both cultivation temperatures (decrease from 10(6) cfu ml-1 to 10(1) cfu ml-1 at 37 degrees C, and from 10(7) cfu ml-1 to 10(5) cfu ml-1 at 30 degrees C). Enterococcus faecium EF 26/42 and Streptococcus bovis AO 24/85, the strains growing in the rumen fluid, were the most sensitive to the addition of enterocin during the first 24 h of fermentation (decrease from 10(10) cfu ml-1 and 10(8) cfu ml-1 to 10(6) cfu ml-1 and 10(4) cfu ml-1). An antilisterial effect of the bacteriocin was also confirmed. Further application of bacteriocin in ruminal ecology was indicated.

Animals↗

Effects of bacterial direct-fed microbials and yeast on site and extent of digestion, blood chemistry, and subclinical ruminal acidosis in feedlot cattle.

Two studies were conducted to determine whether a bacterial direct-fed microbial (DFM) alone or with yeast could minimize the risk of acidosis and improve feed utilization in feedlot cattle receiving high-concentrate diets. Eight ruminally cannulated steers, previously adapted to a high-concentrate diet, were used in crossover designs to study the effects of DFM on feed intake, ruminal pH, ruminal fermentation, blood characteristics, site and extent of digestion, and microbial protein synthesis. Steers were provided ad libitum access to a diet containing steam-rolled barley, barley silage, and a protein-mineral supplement (87, 8, and 5% on a DM basis, respectively). In Exp. 1, treatments were control vs. the lactic-acid producing bacterium Enterococcus faecium EF212 (EF; 6 x 10(9) cfu/d). In Exp. 2, treatments were control vs EF (6 x 10(9) cfu/d) and yeast (Saccharomyces cerevisiae; 6 x 10(9) cfu/d). Supplementing feedlot cattle diets with EF in Exp. 1 increased (P < 0.05) propionate and (P < 0.05) decreased butyrate concentrations, decreased the nadir of ruminal pH (P < 0.05), enhanced the flow of feed N (P < 0.10) to the duodenum but reduced that of microbial N (P < 0.10), reduced (P < 0.10) intestinal digestion of NDF, and increased (P < 0.10) fecal coliform numbers. Other than the increase in propionate concentrations that signify an increase in energy precursors for growth, the other metabolic changes were generally considered to be undesirable. In Exp. 2, providing EF together with yeast abolished most of these undesirable effects. Combining EF with yeast increased the DM digestion of corn grain incubated in sacco, but there were no effects on altering the site or extent of nutrient digestion. The diets used in this study were highly fermentable, and the incidence of subclinical ruminal acidosis, defined as steers with ruminal pH below 5.5 for prolonged periods of time, was high. Supplementing the diet with EF, with or without yeast, had limited effects on reducing ruminal acidosis. It seems that cattle adapted to high-grain diets are able to maintain relatively high feed intake and high fiber digestion despite low ruminal pH. The Enterococcus faecium bacterium and yeast used in this study were of limited value for feedlot cattle already adapted to high-grain diets.

Acidosis↗

Bacteriocin production, plasmid content and plasmid location of enterocin P structural gene in enterococci isolated from food sources.

AIMS: To characterize bacteriocin production, antimicrobial spectrum and plasmid content in bacteriocinogenic enterococci from foods. METHODS AND RESULTS: Bacteriocinogenic Enterococcus faecium (14 isolates) and Enterococcus faecalis (three isolates) showed two different patterns of bacteriocin production in liquid broth: exponential-phase and stationary-phase production. Bacteriocin concentrates from all enterococci were inactivated by trypsin, but seldom by heat (100-117 degrees C), extremes of pH (2.0 to 9.0) or reducing agents (such as dithiothreitol). All bacteriocin concentrates were active against Listeria innocua and Listeria monocytogenes, and most were also active against many Ent. faecalis and Ent. faecium isolates. Enterococci clustered in three main groups according to their plasmid content (which included plasmids from 2.0 to 53 kb). Several isolates from different foods showed almost identical plasmid profiles. The enterocin P structural gene (entP) was detected by hybridization on plasmids of c. 19, 26 and/or 35-38 kb. CONCLUSIONS: Enterococci from food show different patterns of bacteriocin production and different plasmid content in spite of carrying similar bacteriocin-encoding genes. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides information on the diversity of bacteriocinogenic enterococci from food sources carrying apparently similar enterocin genes.

Bacteriocins↗

Comparative in vitro activity of the new glycopeptide SK&F 104662 against problematic gram-positive bacteria.

The in vitro activity of the new glycopeptide antibiotic SK&F 104662 against problematic gram-positive microorganisms was determined using the agar dilution technique. For comparison, ampicillin, oxacillin, vancomycin, erythromycin and gentamicin were tested. SK&F 104662 was found to have high activity against Staphylococcus aureus, coagulase-negative staphylococci (both methicillin sensitive and resistant strains), Enterococcus faecalis, Enterococcus faecium, Listeria monocytogenes, Corynebacterium jeikeium and Corynebacterium group D2. All of 254 isolates, except one vancomycin-resistant strain of Enterococcus faecium, were inhibited by 2 mg/l of SK&F 104662; this compound may thus be potentially useful in the treatment of infections with the above-mentioned gram-positive pathogens.

Anti-Bacterial Agents↗

Lactobacillus rhamnosus GG (ATCC 53103) and platelet aggregation in vitro.

Lactobacillus rhamnosus GG is an experimentally and clinically well documented probiotic used in different dairy products. The present study aimed to investigate the safety aspects of Lactobacillus rhamnosus GG, particularly with respect to platelet aggregation, the initiating event in thrombosis. Platelet rich plasma was separated from the blood of healthy volunteers, and the effects of Lactobacillus rhamnosus GG (ATCC 53103), Lactobacillus rhamnosus (ATCC 7469) and Enterococcus faecium T2L6 in different dilutions on spontaneous, ADP- and adrenaline-induced aggregation were tested. The bacteria did not influence spontaneous aggregation. Only Enterococcus faecium T2L6 enhanced the adrenaline-induced aggregation, with a less clear effect on ADP-induced aggregation.

Adult↗

Prevalence in Singapore of enterococci with high-level resistance to aminoglycosides and comparison of three methods for their detection.

The first study of the prevalence in Singapore of enterococci with high-level resistance to aminoglycosides has been made in the National University Hospital. From March to June 1992, 225 isolates were studied by means of three methods: (1) use of brain-heart infusion (BHI) agar incorporating the antibiotic; (2) microdilution of the antibiotic in broth; and (3) use of high content antibiotic discs. The BHI agar was the reference method. Of the total, 49 (22%) isolates were resistant to gentamicin, 86 (38%) to streptomycin, 82 (36%) to kanamycin and 93 (41%) to one or more of the agents. Results of the disc diffusion method correlated completely with the BHI agar method. The broth microdilution method showed a 100, 90 and 96% sensitivity in relation to gentamicin, streptomycin and kanamycin, respectively, and a specificity of 100% for all three aminoglycosides. Statistical significance (P < 0.01 to P < 0.001) was demonstrated in (1) a greater incidence of enterococci with high-level resistance to aminoglycosides among blood isolates; (2) gentamicin resistance predicting kanamycin high-level resistance; and (3) more resistance to gentamicin, streptomycin and kanamycin among Enterococcus faecium isolates compared to those of Enterococcus faecalis. Beta-lactamase activity was not detected.

Aminoglycosides↗

Epidemiology of bacteriuria caused by vancomycin-resistant enterococci--a retrospective study.

BACKGROUND: The epidemiology of vancomycin-resistant enterococcal (VRE) bacteriuria has not been previously described. Our objectives are to describe the frequency of VRE bacteriuria, to use strict definitions to distinguish symptomatic urinary tract infection (UTI) versus urine colonization without pyuria versus asymptomatic bacteriuria with pyuria, and to describe the outcomes of each group. METHODS: We used a retrospective analysis of patients with VRE bacteriuria in an academic medical center. RESULTS: During the 18-month study period, 98 of the 107 patients (92%) with urine cultures positive for VRE (23/10,000 admissions), had charts that were available for review. In 94 of 98 patients, the organism was Enterococcus faecium, and in only 4 was Enterococcus faecalis recovered. Thirty-seven patients were colonized with VRE; 21 patients had asymptomatic bacteriuria, and the status of 27 patients was not ascertainable. Thirteen patients had VRE UTIs with two associated bacteremias and one death. Patients with UTI versus patients without UTI were more likely to have an underlying malignancy (39% vs 9%, P =.014). CONCLUSION: The majority of urine cultures yielding VRE do not represent true infection, rather colonization or asymptomatic bacteriuria.

Adolescent↗

[Prevalence of vancomycin-resistant enterococci in hospital and community environment.].

AIM OF THE STUDY: The presented study aimed at determining the prevalence of vancomycin-resistant enterococci (VRE) in rectal swabs taken from both patients in the Teaching Hospital in Olomouc (THO), Czech Republic, and subjects from the community setting of the hospital's catchment area. MATERIALS AND METHODS: Between July 1, 2002 and July 1, 2003, rectal swabs were taken from the THO patients as well as individuals from the community catchment area to be utilized for isolating and identifying enterococci and their suscetibility to antibiotics. Vancomycin resistance phenotypes were verified by PCR detection of vanA, vanB, vanC1 and vanC2 genes. A molecular biology analysis was performed in VanA Enterococcus faecium strains. To determine the relationship of strains, macrorestriction analysis of the total chromosomal DNA digested with SmaI restriction endonuclease was used. RESULTS: During the observed period, 2,157 rectal swabs from the hospitalized patients and 4,874 rectal swabs from the subjects in community setting were examined. In total, 27 VRE of hospital origin and 13 community-population strains were isolated. The prevalence of VRE in the gastrointestinal tract was 2.3 % in the hospitalized patients and 0.6 % in the community subjects. The prevailing strains were Enterococcus faecium VanA (70.4 %) in the VRE of hospital origin and Enterococcus gallinarum VanC (46.2 %) in the community VRE. Mutual comparison between the hospital and community VRE showed no similarity. CONCLUSION: In the Czech Republic, VRE were proved both in community and hospital settings. Their prevalence in rectal swabs is low and does not exceed the values reported in other European countries. The author describes the chief characteristics of the most important quinolone antibiotics, including preparations either in their development stage or whose development has been prematurely interrupted because of adverse side-effects. The list includes all preparations that are or were temporarily registered in the Czech Republic.

Anti-Bacterial Agents↗

In-vitro activity of fosfomycin against vancomycin-resistant enterococci.

The effect of fosfomycin against 69 vancomycin-resistant isolates of Enterococcus faecium (VanA), five of E. faecium (VanB), 11 of Enterococcus faecalis (VanA), three of E. faecalis (VanB), 10 of Enterococcus gallinarum (VanC1) and two of Enterococcus casseliflavus (VanC2) and glycopeptide-sensitive E. faecium (n = 8) and E. faecalis (n = 10) was tested in vitro. Fosfomycin inhibited 97%, 94% and 96% of the vancomycin-resistant strains, according to results of agar dilution, broth microdilution, and a disc diffusion method (DIN 58940). The disc diffusion test by the NCCLS method does not include fosfomycin; using breakpoints suggested by Andrews et al. (< or = 11 mm, resistant; > or = 18 mm, susceptible), 5% of the vancomycin-resistant strains tested would have been considered fosfomycin resistant. Minimal inhibitory concentrations of most vancomycin-resistant isolates were in the intermediate sensitivity range, yielding an MIC50 of 32 mg/L and an MIC90 of 64 mg/L. Moreover the majority of inhibitory zone sizes by the disc diffusion method (DIN 58940) corresponded to intermediate susceptibility. These results suggest that fosfomycin at a high dosage and possibly used in combination with other drugs could be a potentially useful drug for the treatment of infections caused by vancomycin-resistant enterococci.

Anti-Bacterial Agents↗

Comparison of LY264826-gentamicin with vancomycin-gentamicin against enterococci from blood cultures.

The combination of the new glycopeptide LY264826 and gentamicin was compared with the combination of vancomycin and gentamicin against 30 strains of enterococci, comprising 20 strains of Enterococcus faecalis, five strains of Enterococcus faecium and five strains of Enterococcus avium, isolated from blood cultures. LY264826 plus gentamicin was synergic against E. faecalis and E. faecium, but not against E. avium.

Anti-Bacterial Agents↗

Effect of abolishment of the use of antimicrobial agents for growth promotion on occurrence of antimicrobial resistance in fecal enterococci from food animals in Denmark.

From 1995 to 2000, a total of 673 Enterococcus faecium and 1,088 Enterococcus faecalis isolates from pigs together with 856 E. faecium isolates from broilers were isolated and tested for susceptibility to four classes of antimicrobial agents used for growth promotion as part of the Danish program of monitoring for antimicrobial resistance. The four antimicrobials were avilamycin, erythromycin, vancomycin, and virginiamycin. Major changes in the use of antimicrobial agents for growth promotion have occurred during the last 6 years in Denmark. The government banned the use of avoparcin in 1995 and of virginiamycin in 1998. Furthermore, the producers have voluntarily stopped all use beginning in 1999. The avoparcin ban in 1995 was followed by a decrease in the occurrence of glycopeptide-resistant E. faecium (GRE) in broilers, from 72.7% in 1995 to 5.8% in 2000. The occurrence of glycopeptide resistance among isolates from pigs remained constant at around 20% from 1995 to 1997. It was shown that, in GRE from pigs, the genes encoding macrolide and glycopeptide resistance were genetically linked and that, following the decrease in the use of tylosin during 1998 and 1999, the occurrence of GRE in pigs decreased to 6.0% in 2000. From 1995 to 1997 the occurrence of erythromycin resistance among E. faecium and E. faecalis isolates from pigs was almost 90%. Use of tylosin decreased considerably during 1998 and 1999, and this decrease was followed by decreases in the occurrence of resistance to 46.7 and 28.1% among E. faecium and E. faecalis isolates from pigs, respectively. Erythromycin resistance among E. faecium isolates from broilers reached a maximum of 76.3% in 1997 but decreased to 12.7% in 2000 concomitantly with more limited use of virginiamycin. Use of virginiamycin increased from 1995 to 1997 and was followed by an increased occurrence of virginiamycin resistance among E. faecium isolates in broilers, from 27.3% in 1995 to 66.2% in 1997. In January 1998 the use of virginiamycin was banned in Denmark, and the occurrence of virginiamycin resistance decreased to 33.9% in 2000. Use of avilamycin increased from 1995 to 1996 and was followed by an increase in avilamycin resistance among E. faecium isolates from broilers, from 63.6% in 1995 to 77.4% in 1996. Since 1996 avilamycin usage has decreased, followed by a decrease in resistance to 4.8% in 2000. Our observations show that it is possible to reduce the occurrence of antimicrobial resistance in a national population of food animals when the selective pressure is removed. Cases in which resistance to vancomycin was linked to resistance to erythromycin were exceptions. In such cases resistance did not decrease until the use of both avoparcin and tylosin was limited.

Animal Diseases↗

Prevalence and characterization of vancomycin-resistant enterococci in chicken intestines and humans of Korea.

The prevalence, genotype for antibiotic resistance and antibiotic susceptibility of vancomycin resistant enterococci (VRE) were determined. And molecular typings of the Enterococcus faecium isolates were analyzed. Prevalence of VRE in chickens, healthy children and intensive care unit (ICU) patients was 41.6%, 7.9%, and 20.4%, respectively. Forty out of 54 isolates from chicken intestines, and 9 out of 11 from ICU patients were identified as Enterococcus faecium. Eleven out of 13 isolates from non-hospitalized young children were E. gallinarium. Twelve strains of E. faecalis were isolated from chicken intestines. The gene for the antibiotic resistance in E. faecium, and E. faecalis was vanA, while that in E. gallinarium was vanC1. E. faecium isolates were resistant to most of antibiotics except ampicillin and gentamicin. Molecular typing of the E. faecium strains obtained by pulse field gel electrophoresis and repetitive sequence-based PCR suggest that VRE transmit horizontally from poultry to humans, especially young children, via the food chains in Korea.

Animals↗

Comparative in vitro activity of LY146032 (daptomycin) against gram-positive cocci.

The in vitro activity of LY146032 was compared with those of seven other antimicrobial agents against gram-positive cocci. MICs of LY146032 were lowest for Streptococcus pneumoniae and methicillin-susceptible Staphylococcus epidermidis (0.25 mg/l). For methicillin-resistant Staphylococcus epidermidis and Staphylococcus aureus the MICs were 1 mg/l, for Enterococcus faecalis 2 mg/l and for Enterococcus faecium 4 mg/l. The activity of LY146032 was in general higher than that of vancomycin. Time-kill studies showed LY146032 had higher bactericidal activity than vancomycin against a methicillin-resistant Staphylococcus aureus strain, and bactericidal activity against Enterococcus faecalis and Enterococcus faecium.

Aminocoumarins↗

Epidemiology of antimicrobial resistance in enterococci of animal origin.

OBJECTIVE: We evaluated the epidemiology of antimicrobial resistance in enterococci from animal farms and the potential relation of resistance to antimicrobial use. METHODS: Enterococci from faecal samples from 18 beef cattle, 18 dairy cattle, 18 swine, 13 chicken, and eight turkey farms were prospectively evaluated over a 6 year period from 1998 to 2003. RESULTS: We evaluated 1256 isolates of Enterococcus faecium and 656 isolates of Enterococcus faecalis. None was vancomycin resistant. Quinupristin/dalfopristin, gentamicin and ciprofloxacin resistance rates in E. faecium were 2%, 0% and 55% in beef cattle, 8%, 7% and 47% in dairy cattle, 21%, 1% and 47% in swine, 85%, 12% and 23% in chicken, and 52%, 13% and 24% in turkey isolates, respectively. For E. faecalis, gentamicin resistance rates were 0% in beef cattle, 24% in dairy cattle, 37% in swine, 32% in chicken, and 29% in turkey isolates, whereas 12%, 9%, 21%, 64% and none of isolates from beef, dairy, swine, chicken, and turkey farms, respectively, were resistant to ciprofloxacin. Quinupristin/dalfopristin resistance in E. faecium was more common on chicken and turkey farms using virginiamycin (P<0.0001 for both) compared with farms not using a streptogramin, gentamicin resistance was more common on dairy farms using gentamicin (P<0.0001) compared with farms not using this antibiotic, and ciprofloxacin resistance was more common on turkey and dairy farms using enrofloxacin compared with those with no enrofloxacin use (P=0.02 and P=0.04, respectively). For E. faecalis, gentamicin resistance was more frequently detected on dairy and swine farms using gentamicin (P<0.0001 and P=0.0052, respectively) and ciprofloxacin resistance was more common on beef farms using enrofloxacin (P<0.0001) compared with farms not using these antimicrobials. PFGE showed multiple strain types with some clones common between animals of the same animal species. CONCLUSIONS: This study shows the presence of a significant reservoir of antibiotic-resistant enterococci among farm animals. Resistance was more common on farms using antimicrobial agents.

Agriculture↗

Resistance of enterococci to ampicillin and glycopeptide antibiotics in Italy. The Italian Surveillance Group for Antimicrobial Resistance.

We report the results of the monitoring of resistance to ampicillin, vancomycin, and teicoplanin in enterococci by an Italian network of clinical microbiology laboratories. A total of 16,226 strains were analyzed; 9,169 of these strains were Enterococcus faecalis, 913 were Enterococcus faecium, and 6,144 were Enterococcus species. The average rate of resistance to ampicillin was 1.9% (range, 0-6.5%) for E. faecalis and 70% (range, 33.3%-98.7%) for E. faecium; the average rate of resistance to vancomycin was 1.1% (range, 0.1%-2%) for E. faecalis and 8.5% (range, 0-36.1%) for E. faecium; and the average rate of resistance to teicoplanin was 0.8% (range, 0-2.4%) for E. faecalis and 8.7% (range, 0-36.1%) for E. faecium.

Ampicillin Resistance↗

Screening of some plants from Northern Argentina for their antimicrobial activity.

AIMS: Screening of antimicrobial activity in 25 plant species from Northern Argentina. METHODS AND RESULTS: Inhibition of microbial growth was measured by a microplate assay with an oxidation-reduction indicator (Alamar Blue). Test organisms were: Escherichia coli, Salmonella typhimurium, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Enterococcus faecium. Weak inhibitory activities (MIC=0.5 mg dry matter ml(-1)) were found in methanolic extracts of Rivina humilis, Crateva tapia, Funastrum claucum and Schinopsis balansae. Stronger bacteriostatic power was detected in Vassobia breviflora (MIC=0.25 mg ml(-1) against Staphylococcus aureus, and 0.5 mg ml(-1) against Enterococcus faecium). This activity was purified five-fold by extraction with dichloromethane, and it was found equally effective against susceptible or antibiotic-resistant strains of Staph. aureus. In addition, the purified extract was synergistic with gentamicin, and it was bactericidal at 24 h, with a concentration of 0.25 mg ml(-1). CONCLUSION: There is a significant antimicrobial activity in Vassobia breviflora. SIGNIFICANCE AND IMPACT OF THE STUDY: Further studies will be required to disclose the potential importance of these findings.

Anti-Bacterial Agents↗

Classification and characterization of lactic acid bacteria isolated from the intestines of common carp and freshwater prawns.

Fifty-four isolates of lactic acid bacteria were obtained from the intestines of the common carp (Cyprinus carpio) and freshwater prawns (Macrobrachium rosenbergii) in Nakorn-Pathom Province, Thailand. All isolates were Gram-positive and catalase-negative cocci that did not produce gas from glucose and formed dl or L(+) lactic acid only. Most isolates were able to grow in broth at pH 9.6, in 6.5% NaCl (w/v) and 40% (w/v) bile. These isolates were divided into six groups (A-F) by sugar fermentation patterns. Strains in the groups A, B, C, and D showed intergroup DNA homology values of above 73.8%, indicating that these groups were composed of a single species. Following phylogenetic analysis, strains E 1, E 7, and E 26 from groups A, E, and F were placed in the clusters of the genera Lactococcus, Pediococcus, and Enterococcus, respectively. The type strains of Lactococcus garvieae, Pediococcus acidilactici, and Enterococcus faecium were the most closely related species with E 1, E 7, and E 26 in the phylogenetic tree, respectively. The DNA-DNA hybridization results indicated that strains in groups A (including groups B, C, and D), E, and F could be identified as belonging to the species Lactococcus garvieae, Pediococcus acidilactici, and Enterococcus faecium, respectively. Lactococcus garvieae was the dominant member of the population, accounting for 90.7% of the isolates.

Journal Article↗

Activity of trovafloxacin (with or without ampicillin-sulbactam) against enterococci in an in vitro dynamic model of infection.

Antibiotic-resistant enterococci are being increasingly identified as causal agents of infection. Trovafloxacin is a new fluoronaphthyridone with enhanced activity against gram-positive cocci and variable activity reported against Enterococcus spp. Twenty-one strains of vancomycin-resistant Enterococcus faecium and two strains of Enterococcus faecalis (one vancomycin resistant) were studied at an initial inoculum of 10(6) CFU/ml in time-kill assays with trovafloxacin (3 mg/liter), ampicillin-sulbactam (100/50 mg/liter), and the combination. Six strains of E. faecium (five vancomycin resistant) also were studied in an in vitro two-compartment dynamic model that mimics human pharmacokinetics with trovafloxacin simulated at 300 mg every 12 h (q12h), ampicillin-sulbactam at 2/1 g q6h, and the combination. Peripheral compartments were sampled q2h for 30 h for bacterial counts. Trovafloxacin MICs ranged from 0.5 to 32 mg/liter, and the nine strains of vancomycin-resistant E. faecium for which MICs were < or =2 mg/liter were more likely to show a reduction of 2 log units or more in viable counts in time-kill assays than were strains for which MICs were higher. Synergism with ampicillin-sulbactam was found for only one strain (trovafloxacin MIC, 16 mg/liter). Similar results were obtained in the pharmacokinetic model, with 2- to 4-log-unit reductions in viable bacteria for trovafloxacin-susceptible strains. Although no convincing evidence of synergism was found, ampicillin-sulbactam in combination minimized late bacterial regrowth of two trovafloxacin-susceptible strains. These data suggest that this high dose of trovafloxacin (with or without ampicillin-sulbactam) might be useful against strains of vancomycin-resistant E. faecium for which MICs were < or =2 mg/liter.

Ampicillin↗