The mechanism of acquired, high-level resistance to vancomycin involves:
a. enzymatic destruction of the antibiotic.
b. altered antibiotic targets.
c. decreased intracellular uptake of the drug.
d. production of altered cell wall precursors that do not bind the antibiotic with suffi-cient avidity.
D
The mechanism involves altered cell wall precursors that do not bind vancomycin with sufficient avidity to allow the inhibition of peptidoglycan-synthesizing enzymes. The altered targets are readily incorporated into the cell wall, enabling synthesis to progress as usual.
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