{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T17:29:11Z","timestamp":1777483751946,"version":"3.51.4"},"reference-count":32,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2006,3,13]],"date-time":"2006-03-13T00:00:00Z","timestamp":1142208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2006,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>The clinical significance of infections caused by vancomycin\u2010tolerant (Vt) Gram\u2010positive organisms in patients with cancer remains unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Twenty\u2010five patients with nonenterococcal Gram\u2010positive bloodstream infection, which was refractory to vancomycin therapy, were identified by reviewing the Infectious Diseases consultation database at the tertiary care cancer center. Among these, 8 patients in whom vancomycin\u2010tolerance was documented are described. Antibiotic tolerance was defined as a &gt;32 times increase in minimum bactericidal concentration compared with minimum inhibitory concentration.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Eight patients with persistent fever and bacteremia of &gt;72 hours' duration after the initiation of vancomycin therapy were treated. The median age of these patients, which included 3 men and 5 women, was 44 years \u00b1 11 years. Solid tumors were more common (6 patients) and 2 patients had acute leukemia. Six patients (75%) were neutropenic (absolute neutrophil count &lt;500\/mm<jats:sup>3<\/jats:sup>), including 2 breast cancer patients who had undergone autologous stem cell transplantation. The causative organisms were <jats:italic>Staphylococcus aureus<\/jats:italic> (<jats:italic>n<\/jats:italic> = 3 patients), group G streptococci (<jats:italic>n<\/jats:italic> = 2 patients), and <jats:italic>Staphylococcus epidermidis<\/jats:italic>, <jats:italic>Streptococcus mitis<\/jats:italic>, and <jats:italic>Streptococcus sanguis<\/jats:italic> (1 patient each). All isolates demonstrated a minimum bactericidal concentration for vancomycin that was at least 32 times greater than the minimum inhibitory concentration. Rapid defervescence (\u226424 h) and resolution of bacteremia occurred with the addition of gentamicin (4 patients) or gentamicin plus rifampin (4 patients). None of these infections recurred after discontinuation of therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Lack of clinical and\/or microbiologic response to vancomycin should raise the suspicion of possible infection due to Vt Gram\u2010positive bacteria, and alternative bactericidal therapy should be instituted early, especially in patients with underlying immune suppression. Cancer 2006. \u00a9 2006 American Cancer Society.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.21801","type":"journal-article","created":{"date-parts":[[2006,3,13]],"date-time":"2006-03-13T14:48:47Z","timestamp":1142261327000},"page":"1815-1820","source":"Crossref","is-referenced-by-count":47,"title":["Vancomycin tolerance, a potential mechanism for refractory gram\u2010positive bacteremia observational study in patients with cancer"],"prefix":"10.1002","volume":"106","author":[{"given":"Amar","family":"Safdar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth V. I.","family":"Rolston","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,3,13]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1086\/374339"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1086\/598620"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(99)80216-2"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1086\/520192"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1086\/322604"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1086\/339215"},{"key":"e_1_2_5_8_2","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1128\/AAC.43.4.940","article-title":"Comparison of activity of broad\u2010spectrum B\u2010lactam compounds against 1,128 Gram\u2010positive cocci recently isolated in cancer treatment centers","volume":"43","author":"Diekema DJ","year":"1999","journal-title":"Antimicrob Agents Chemother."},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0732-8893(99)00010-3"},{"key":"e_1_2_5_10_2","doi-asserted-by":"publisher","DOI":"10.1086\/598621"},{"key":"e_1_2_5_11_2","first-page":"767","article-title":"Staphylococcus aureus with reduced susceptibility to vancomycin\u2010United States 1997","volume":"46","author":"Centers for Disease Control and Prevention","year":"1997","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"e_1_2_5_12_2","doi-asserted-by":"publisher","DOI":"10.1086\/318697"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1086\/381202"},{"key":"e_1_2_5_14_2","doi-asserted-by":"publisher","DOI":"10.1038\/227138a0"},{"key":"e_1_2_5_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/152.2.365"},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.1038\/21202"},{"key":"e_1_2_5_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/44.1.121"},{"key":"e_1_2_5_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/13.4.389"},{"key":"e_1_2_5_19_2","doi-asserted-by":"crossref","first-page":"3380","DOI":"10.1128\/JCM.37.10.3380-3383.1999","article-title":"Antibiotic susceptibility of group C and group G streptococci isolated from patients with invasive infections: evidence of vancomycin tolerance among group G serotypes","volume":"37","author":"Zaoutis T","year":"1999","journal-title":"J Clin Microbiol."},{"key":"e_1_2_5_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/42.2.189"},{"key":"e_1_2_5_21_2","first-page":"1000","volume-title":"Manual of Clinical Microbiology","author":"Schoenknecht FD","year":"1985"},{"key":"e_1_2_5_22_2","volume-title":"Methodology for determining bactericidal activity test","author":"National Committee for Clinical Laboratory Standards","year":"1999"},{"key":"e_1_2_5_23_2","volume-title":"Methods for determining bactericidal activity of antimicrobial agents","author":"National Committee for Clinical Laboratory Standards","year":"1999"},{"key":"e_1_2_5_24_2","volume-title":"Diagnostic microbiology","author":"Koneman EW","year":"1988"},{"key":"e_1_2_5_25_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.032671699"},{"key":"e_1_2_5_26_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.42.6.2398-2402.2004"},{"key":"e_1_2_5_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1097-2765(00)80402-5"},{"key":"e_1_2_5_28_2","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1515\/9783110866544-026","volume-title":"The Target of Penicillin","author":"Tomasz A","year":"1983"},{"key":"e_1_2_5_29_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.38.3.487"},{"key":"e_1_2_5_30_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-97-4-496"},{"key":"e_1_2_5_31_2","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1001\/archinte.1979.03630460058018","article-title":"Serious staphyloccal infections with strains tolerant to bactericidal antibiotics","volume":"139","author":"Denny AE","year":"1979","journal-title":"Arch Intern Med."},{"key":"e_1_2_5_32_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.47.6.1984-1987.2003"},{"key":"e_1_2_5_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-0704(05)70198-6"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcncr.21801","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.21801","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T12:45:11Z","timestamp":1760273111000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.21801"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,3,13]]},"references-count":32,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2006,4,15]]}},"alternative-id":["10.1002\/cncr.21801"],"URL":"https:\/\/doi.org\/10.1002\/cncr.21801","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,3,13]]}}}