European Journal of Clinical Microbiology

, Volume 5, Issue 1, pp 93–97 | Cite as

Serum bactericidal titer as a predictor of outcome in endocarditis

  • C. J. Hackbarth
  • H. F. Chambers
  • M. A. Sande


A study was conducted in 89 rabbits with experimental aortic valve endocarditis caused by three different strains ofStaphylococcus aureusto determine whether there was a correlation between the peak serum bactericidal titer of the four drugs tested and the vegetation titer. After four days of therapy both the rabbits with and those without sterile vegetations had median peak bactericidal titers of 1∶8. The mean vegetation titers did not correlate with the mean bactericidal titers. The serum bactericidal test does not measure the relative rate of killing of the bacteria by the drugs. Although the test remains clinically useful for documentation of bactericidal activity, the minimum level of activity necessary for the test to serve as a predictor of outcome remains to be defined.


Internal Medicine Bactericidal Activity Aortic Valve Endocarditis Relative Rate 
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  1. 1.
    Schlichter, J. G., MacLean, H.: A method of determining the effective therapeutic level in the treatment of subacute bacterial endocarditis with penicillin: a preliminary report. American Heart Journal, 1947, 34: 209–211.Google Scholar
  2. 2.
    Eagle, H.: Speculations as to the therapeutic significance of the penicillin blood level. Annals of Internal Medicine 1948, 28: 260–278.Google Scholar
  3. 3.
    Eagle, H., Musselman, A. D.: The role of bactericidal action of penicillin in vitro as a function of its concentration, and its paradoxically reduced activity at high concentrations against certain organisms. Journal of Experimental Medicine 1948, 88: 99–131.Google Scholar
  4. 4.
    Schlichter, J. G., MacLean, H., Milzer, A.: Effective penicillin therapy in subacute bacterial endocarditis and other chronic infections. American Journal of Medical Science 1949, 217: 600–609.Google Scholar
  5. 5.
    Finland, M.: Treatment of bacterial endocarditis. New England Journal of Medicine 1954, 250: 372–383, 419–428.PubMedGoogle Scholar
  6. 6.
    Jawetz, E.: Assay of antibacterial activity in serum. American Journal of Diseases of Children 1962, 103: 113–116.Google Scholar
  7. 7.
    Scheld, W. M., Sande, M. A.: Endocarditis and intravascular infections. In: Mandell, G. L., Douglas, Jr., R.G., Bennett, J. E. (ed.): Principles and practice of infectious diseases. Wiley Medical Publication, New York, 1985, p. 504–529.Google Scholar
  8. 8.
    Jordan, G., Kawachi, M.: Analysis of serum bactericidal activity in endocarditis, osteomyelitis, and other bacterial infections. Medicine 1981, 60: 49–61.PubMedGoogle Scholar
  9. 9.
    Greenman, R., Arcey, S., Gutterman, D., Zweig, R.: Twice-daily intramuscular ceforanide therapy ofStaphylococcus aureus endocarditis in parenteral drug abusers. Antimicrobial Agents and Chemotherapy 1984, 25: 16–19.PubMedGoogle Scholar
  10. 10.
    Coleman, D. L., Horwitz, R. I., Andriole, V. T.: Association between serum inhibitory and bactericidal concentrations and therapeutic outcome in bacterial endocarditis. American Journal of Medicine 1982, 73: 262–269.PubMedGoogle Scholar
  11. 11.
    Weinstein, M. P., Stratton, C. W., Ackley, A., Hawley, H. B., Robinson, P. A., Fisher, B. D., Alcid, D. V., Stephens, D. S., Reller, L. B.: Multicenter collaborative evaluation of a standardized serum bactericidal test as a prognostic indicator in infective endocarditis. American Journal of Medicine 1985, 78: 262–269.PubMedGoogle Scholar
  12. 12.
    Chambers, H. F., Hackbarth, C. J., Drake, T. A., Rusnak, M. G., Sande, M. A.: Endocarditis due to methicillinresistantS. aureus in rabbits: expression of resistance toβ-lactam antibiotics in vivo and in vitro. Journal of Infectious Diseases 1984, 6: 894–903.Google Scholar
  13. 13.
    Jones, R. N., Barry, A. L., Gavan, T. L., Washington II, J. A.: Susceptibility tests: microdilution and macrodilution broth procedures. In: Lennette, E. H., Balows, A., Hausler, Jr., W. J., Shadomy, H. J. (ed.): Manual of clinical microbiology. American Society for Microbiology, Washington, D.C., 1985, p. 972–977.Google Scholar
  14. 14.
    Garrison, P. K., Freedman, L. R.: Experimental endocarditis. I. Staphylococcal endocarditis in rabbits resulting from placement of a polyethylene catheter in the right side of the heart. Yale Journal of Biological Medicine 1970, 42: 394–410.Google Scholar
  15. 15.
    Sande, M. A., Johnson, M. L.: Antimicrobial therapy of experimental endocarditis caused byStaphylococcus aureus. Journal of Infectious Diseases 1975, 131: 367–375.PubMedGoogle Scholar
  16. 16.
    Chambers, H. F., Sande, M. A.: Teicoplanin versus nafcillin and vancomycin in the treatment of experimental endocarditis caused by methicillin-susceptible or resistantStaphylococcus aureus. Antimicrobial Agents and Chemotherapy 1984, 26: 61–64.PubMedGoogle Scholar
  17. 17.
    Edberg, S. C., Sabath, L. D.: Determination of antibiotic levels in body fluids: techniques and significance. In: Lorian, V. (ed.): Antibiotics in laboratory medicine. Williams & Wilkins Co., Baltimore, 1980, p. 206–264.Google Scholar
  18. 18.
    Schoenknecht, F. D., Sabath, L. D., Thornsberry, C.: Susceptibility tests: special test. In: Lennette, E. H., Balows, A., Hausler, Jr., W. J., Shadomy, H. J. (ed.): Manual of clinical microbiology. American Society for Microbiology, Washington, D. C., 1985, p. 1000–1008.Google Scholar
  19. 19.
    Ransohoff, D. F., Feinstein, A. R.: Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. New England Journal of Medicine 1978, 299: 926–930.PubMedGoogle Scholar
  20. 20.
    Stratton, C. W., Weinstein, M. P., Reller, L. B.: Correlation of serum bactericidal activity with antimicrobial agent level and minimal bactericidal concentration. Journal of Infectious Diseases 1982, 145: 160–168.PubMedGoogle Scholar
  21. 21.
    Carrizona, J., Kaye, D.: Antibiotic concentrations in serum, serum bactericidal activity, and results of therapy of streptococcal endocarditis in rabbits. Antimicrobial Agents and Chemotherapy 1977, 12: 749–483.Google Scholar
  22. 22.
    Fass, R. J.: Laboratory tests for designing bactericidal activity as predictors of antibiotic efficacy in the treatment of endocarditis due toStaphylococcus aureus in rabbits. Journal of Infectious Diseases 1984, 149: 904–912.PubMedGoogle Scholar
  23. 23.
    Drake, T. A., Hackbarth, C. J., Sande, M. A.: Value of serum tests in combined drug therapy of endocarditis. Antimicrobial Agents and Chemotherapy 1983, 24: 653–657.PubMedGoogle Scholar

Copyright information

© Friedr. Vieweg & Sohn Verlagsgesellschaft mbH 1986

Authors and Affiliations

  • C. J. Hackbarth
    • 1
  • H. F. Chambers
    • 1
  • M. A. Sande
    • 1
    • 2
  1. 1.Department of Medicine, School of MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.The Medical ServiceSan Francisco General HospitalSan FranciscoUSA

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