DONALD KAYE, M.D.
The article in this issue by Rajashekaraiah and co-workers (1) raises the issue of the clinical significance of a laboratory phenomenon, tolerance of Staphylococcus aureus to beta-lactam antibiotics. Three questions must be addressed in evaluating the observations of these authors, who concluded that tolerance of S. aureus to penicillinase-resistant penicillins and cephalosporins leads to poor results in therapy of S. aureus endocarditis. They are  what exactly is tolerance, and how frequently does it occur?  What is the evidence that it has clinical significance?  What should be the approach to patients with endocarditis caused by tolerant S. aureus?
KAYE D. The Clinical Significance of Tolerance of Staphylococcus aureus. Ann Intern Med. ;93:924–926. doi: 10.7326/0003-4819-93-6-924
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Published: Ann Intern Med. 1980;93(6):924-926.
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