Antimicrobial susceptibility and selection of resistance among Staphylococcus epidermidis isolates recovered from patients with infections of indwelling foreign devices.

Twenty-seven isolates of Staphylococcus epidermidis from patients with prosthetic valve endocarditis or infected cerebrospinal fluid shunts were examined for susceptibility to antimicrobial agents. Subpopulations resistant to 20 and 100 mug of methicillin per ml were present in 63% of the isolates (methicillin-resistant isolates). Subpopulations resistant to 20 mug of nafcillin and cephalothin per ml were found in every methicillin-resistant isolate but with frequencies (10(-5.0 +/- 0.5) and 10(-6.4 +/- 0.9), respectively) which were not always detectable by susceptibility testing. Resistance to >/=1.6 mug of penicillin per ml was found in 80% of isolates. Cephalothin, cefazolin, and cefamandole were more active than cefoxitin or cephradine, and gentamicin was more active than tobramycin or amikacin; rifampin was the single most active agent against all isolates. There was no difference in susceptibility between prosthetic valve endocarditis and cerebrospinal fluid shunt infection isolates. Among methicillin-resistant isolates, the phenotypic expression of resistance to methicillin or nafcillin but not to cephalothin could be enhanced by 48 h of incubation with each drug. Isolates containing no methicillin-resistant subpopulations were killed by incubation with methicillin, nafcillin, or cephalothin. High-level resistance to rifampin emerged in both methicillin-resistant and methicillin-sensitive isolates after 8 to 24 h of incubation with this drug. The presence or absence of antibiotic-resistant subpopulations among S. epidermidis isolates and their selection during treatment should be considered when therapy is devised.