Vancomycin-Dependent Enterococci: A Clinical and Laboratory Assessment

  • Henry S. Fraimow
  • Donald L. Jungkind
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 390)

Abstract

Bacterial organisms with unusual nutritional requirements are occasionally isolated from clinical specimens, and their detection provides a major challenge to the clinical microbiology laboratory.1 Among the more unusual nutritionally deficient organisms are those that demonstrate a specific growth requirement for antimicrobial agents. Although strains with a wide variety of antibiotic growth requirements can be constructed in vitro, clinical “antibiotic-dependent” isolates appear to occur only infrequently.2,3,4 The most well known examples of “antibiotic-dependent” organisms are streptomycin-dependent bacteria, which were first recognized shortly after the introduction of streptomycin.2,4,5 Dependence on other antibiotics such as tetracyclines and chloramphenicol has also been noted in vivo, but these phenomena have been only poorly characterized.2,6 We and others have recently reported on the isolation of strains of Enterococcus faecalis and Enterococcus faecium demonstrating specific requirements for glycopeptide antimicrobial agents.7–10 In this chapter, the clinical and laboratory features and proposed mechanism of vancomycin-dependence of the first of these isolates, strain TJ310, is described in detail, and the available information on several other clinical vancomycin-dependent isolates is reviewed. In addition to their importance as examples of extreme bacterial adaptation in the face of ongoing selective antimicrobial pressure, such strains may also provide significant clues to the basic mechanisms of glycopeptide resistance.

Keywords

Pancreatitis Alanine Vancomycin Tetracycline Chloramphenicol 

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Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Henry S. Fraimow
    • 1
  • Donald L. Jungkind
    • 1
  1. 1.Department of Medicine, The Graduate Hospital; Department of PathologyJefferson Medical CollegePhiladelphiaUSA

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