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Antibacterial action of vancomycin and mechanism of resistance. Vancomycin inhibits cell wall synthesis by binding to D-Ala-D-Ala residues of peptidoglycan precursor molecules (A). In vancomycin-resistant S. aureus, D-Ala-D-Ala residues of the peptidoglycan precursor molecule are replaced by D-Ala-D-Lac residues, which do not bind vancomycin. Peptidoglycan cross-linking occurs normally (B).
