The ability of daptomycin to produce bactericidal activity against Staphylococcus aureus while causing negligible cell lysis has been demonstrated using electron microscopy and the membrane integrity probes calcein and ToPro3. The formation of aberrant septa on the cell wall, suggestive of impairment of the cell division machinery, was also observed.Many antibiotics derive bactericidal activity from their ability to lyse cells, which may cause liberation of potent proinflammatory bacterial components, resulting in the generation of a robust innate immune response that can potentially cause harm to the host (8). The lipopeptide antibiotic daptomycin is active against a wide range of gram-positive bacteria (Cubicin prescription information, 2005; Cubist Pharmaceuticals, Lexington, MA) (4) and is believed to possess a novel mechanism of action that does not involve cell lysis. Instead, the lipophilic acyl tail of daptomycin is inserted into the cytoplasmic membrane of the bacterium, leading to potassium efflux; destruction of the ion-concentration gradient; membrane depolarization; inhibition of protein, DNA, and RNA synthesis; and finally cell death (Cubicin prescription information, 2005; Cubist Pharmaceuticals, Lexington, MA) (5, 11, 13). Daptomycin is rapidly bactericidal in vitro against Staphylococcus aureus at low multiples of the MIC (12). Here, we demonstrate the bactericidal activity of daptomycin against S. aureus in the absence of cell lysis. (Portions of this work were presented previously at the 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy [10].)Cell lysis was initially monitored by measuring optical density during log-phase time kills. Late-exponential-phase cultures (approximately 10 8 CFU/ml) were used to allow samples to be obtained for transmission electron microscopy (TEM). Staphylococcus aureus ATCC 29213 was grown overnight in calcium-supplemented Mueller-Hinton broth (MHBc; 50 mg/ liter Ca 2ϩ ) and subcultured 1:1,000 into fresh MHBc. Cultures were grown at 37°C with shaking (200 rpm) to an optical density at 600 nm (OD 600 ) of 0.3 to ensure sufficient biomass for fixation and processing. Daptomycin was added at multiples (1ϫ to 8ϫ) of the MIC (0.5 g/ml). At the indicated time points, samples were removed, OD 600 and number of CFU/ml were measured as previously described (7), and cells were pelleted and resuspended in 1 ml MHBc plus 2.5% (vol/vol) glutaraldehyde. Glutaraldehyde-fixed samples were postfixed in 2.0% (wt/vol) osmium tetroxide, followed by en bloc staining with 2.0% (wt/vol) uranyl acetate. The cells were then dehydrated through an ethanol series and embedded in LR White resin. Samples were thin sectioned and stained by uranyl acetate; lead citrate TEM was performed using a LEO 912AB microscope under standard operating conditions at 100 kV, with a liquid nitrogen anticontaminator in place.As shown in Fig. 1, at 4 g/ml, daptomycin was rapidly bactericidal, producing a Ͼ1,000-fold decrease in viability in less than 120 min, with no concomitant drop in OD 6...