Gram-negative bacteria are normally resistant to the antibiotic vancomycin (VAN), which cannot significantly penetrate the outer membrane. We used Escherichia coli mutants that are partially sensitive to VAN to study synergies between VAN and 10 other antibiotics representing six different functional categories. We detected strong synergies with VAN and nitrofurantoin (NTR) and with VAN and trimethoprim (TMP) and moderate synergies with other drugs, such as aminoglycosides. These synergies are powerful enough to show the activity of VAN against wild-type E. coli at concentrations of VAN as low as 6.25 g/ml. This suggests that a very small percentage of exogenous VAN does enter E. coli but normally has insignificant effects on growth inhibition or cell killing. We used the results of pairwise interactions with VAN V ancomycin (VAN) has proved to be an effective antibiotic against certain multidrug-resistant Gram-positive pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA). However, the large size of this glycopeptide precludes it from being useful against Gram-negative bacterial infections, since the outer membrane of Gram-negative bacteria acts as a barrier to its entry into the cell (1). Finding agents that act synergistically with VAN against Gram-negative bacteria would be valuable in treating infections caused by multidrug-resistant pathogens, such as carbapenem-resistant Klebsiella pneumoniae, a leading cause of hospitalacquired pneumonia in the United States (2). Certain mutants of Escherichia coli with gene knockouts that affect outer membrane assembly (surA [3] and smpA [4] mutants) display increased sensitivity to VAN. Recently, we have found that E. coli mutants lacking deoxycytidine deaminase (DCD) also are more sensitive to VAN than wild-type (WT) strains (5). In the work reported here, we have used surA and dcd mutants to study drug interactions between VAN and a series of antibiotics in E. coli. We detected strong synergies between VAN and nitrofurantoin (NTR) and between VAN and trimethoprim (TMP). We then tested different concentrations of each of these two antibiotics both alone and in combination with VAN in the wild-type background and demonstrated that wild-type cells are sensitized to relatively low concentrations of VAN in the presence of subinhibitory concentrations of either NTR or TMP. We discuss the possible implications of these results for combination drug therapy.
MATERIALS AND METHODSE. coli strains. The DCD-deficient and SurA-deficient strains used here are from the Keio Collection, described by Baba et al. (6), and were made from the starting strain BW25113 (7). This starting strain (lacI q rrnB T14 ⌬lacZ WJ16 hsdR514 ⌬araBAD AH33 ⌬rhaBAD LD78 ) is used as the WT in the experiments reported here, unless otherwise stated. BW25113 is closely related to MG1655, as both are derived from the strain W1485 background (6). The dcd mutant and the surA mutant carry a complete deletion of the dcd gene and the surA gene, respectively, with a kan kanamycin resistance gene ...