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Background  There is no clear relationship between  in vitro  bactericidal activity tests and clinical outcome. We studied bactericidal activity of oxacillin, vancomycin and teicoplanin against  Staphylococcus aureus  isolates in patients with endocarditis and then we sought to determine if there was a relationship between  in vitro  bactericidal activity and clinical outcome.    Methods  Minimal bacteriostatic and minimal bactericidal concentrations were determined for  Staphylococcus aureus  strains isolated from patients with endocarditis following standardized methods. Medical records were reviewed retrospectively to collect data on antimicrobial susceptibility at admission, antimicrobial therapy, need for surgery, embolic events and outcome.    Results and Discussion  Sixty-two  Staphylococcus aureus  strains were studied in 62 patients with endocarditis. Overall, 91.9% definite, 21% methicillin resistant and 72.6% cured. Surgery was performed in 32.3% and embolic events were documented in 64.5%. Tolerance to oxacillin and teicoplanin was more common than vancomycin tolerance among methicillin susceptible  Staphylococcus aureus . Among methicillin resistant  Staphylococcus aureus  teicoplanin was shown to have a higher rate of tolerance than vancomycin. No statistically significant differences on clinical outcome between oxacillin tolerant and oxacillin non tolerant  Staphylococcus aureus  infections were observed. Tolerance to oxacillin did not adversely affect clinical outcomes of patients with methicillin susceptible  Staphylococcus aureus  endocarditis treated with a combination of antimicrobials including oxacillin. The cure rate was significantly lower among patients with methicillin resistant  Staphylococcus aureus  endocarditis.    Conclusions  In vitro bactericidal test results were not valid predictors of clinical outcome. Physicians need to use additional parameters when treating patients with staphylococcal endocarditis.

annals of clinical microbiology and antimicrobials

Bactericidal activity of oxacillin and glycopeptides against Staphylococcus aureus in patients with endocarditis: Looking for a relationship between tolerance and outcome