1
|
Carvajal LP, Rincon S, Gomez Villegas SI, Matiz-Gonzalez JM, Ordoñez K, Santamaria A, Ospina Navarro L, Beltran J, Guevara F, Mendez YR, Salcedo S, Porras A, Valencia-Moreno A, Greenia H, Deyanov A, Baptista R, Tam VH, Panesso D, Tran TT, Miller WR, Arias CA, Reyes J. Prevalence of the cefazolin inoculum effect (CzIE) in nasal colonizing methicillin-susceptible Staphylococcus aureus in patients from intensive care units in Colombia and use of a modified rapid nitrocefin test for detection. Antimicrob Agents Chemother 2024; 68:e0089824. [PMID: 39345182 DOI: 10.1128/aac.00898-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 09/10/2024] [Indexed: 10/01/2024] Open
Abstract
The cefazolin inoculum effect (CzIE) has been associated with poor clinical outcomes in patients with methicillin-susceptible Staphylococcus aureus (MSSA) infections. We aimed to investigate the point prevalence of the CzIE among nasal colonizing MSSA isolates from ICU patients in a multicenter study in Colombia (2019-2023). Patients underwent nasal swabs to assess for S. aureus colonization on admission to the ICU, and some individuals had follow-up swabs. We performed cefazolin MIC by broth microdilution using standard and high inoculum and developed a modified nitrocefin-based rapid test to detect the CzIE. Whole-genome sequencing was carried out to characterize BlaZ types and allotypes, phylogenomics, and Agr-typing. A total of 352 patients were included; 46/352 (13%) patients were colonized with S. aureus and 22% (10/46) and 78% (36/46) with MRSA and MSSA, respectively. Among 36 patients who contributed with 43 MSSA colonizing isolates, 21/36 (58%) had MSSA exhibiting the CzIE. BlaZ type A and BlaZ-2 were the predominant type and allotype in 56% and 52%, respectively. MSSA belonging to CC30 were highly associated with the CzIE, and single-nucleotide polymorphism (SNP) analyses supported possible transmission of MSSA exhibiting the CzIE among some patients of the same unit. The modified nitrocefin rapid test had 100%, 94.4%, and 97.7% sensitivity, specificity, and accuracy, respectively. We found a high point prevalence of the CzIE in MSSA colonizing the nares of critically ill patients in Colombia. A modified rapid test was highly accurate in detecting the CzIE in this patient population.
Collapse
Affiliation(s)
- Lina P Carvajal
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
| | - Sandra Rincon
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
| | | | - J Manuel Matiz-Gonzalez
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
| | - Karen Ordoñez
- Department of Infectious Diseases, ESE Hospital Universitario,San Jorge de Pereira, Pereira, Colombia
| | - Alejandra Santamaria
- Department of Infectious Diseases, ESE Hospital Universitario,San Jorge de Pereira, Pereira, Colombia
| | | | | | - Fredy Guevara
- Servicio de Infectología, Fundación Santafe de Bogota, Bogota, Colombia
- Clinica Reina Sofia, Colsanitas, Bogota, Colombia
| | - Yardany R Mendez
- Grupo de Investigacion en Epidemiologia Clinica de Colombia (GRECO), Universidad Pedagogica y Tecnologica de Colombia, Tunja, Colombia
- Hospital Regional de Duitama, Duitama, Colombia
| | - Soraya Salcedo
- Organizacion Clinica General del Norte, Barranquilla, Colombia
| | | | | | - Haley Greenia
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, Texas, USA
| | - Alexander Deyanov
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, Texas, USA
| | - Rodrigo Baptista
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, Texas, USA
- Division of Infectious Diseases and Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Vincent H Tam
- Departament of Pharmacy Practice and Translational Research, University of Houston, Houston, Texas, USA
| | - Diana Panesso
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, Texas, USA
- Division of Infectious Diseases and Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Truc T Tran
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, Texas, USA
- Division of Infectious Diseases and Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - William R Miller
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, Texas, USA
- Division of Infectious Diseases and Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Cesar A Arias
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, Texas, USA
- Division of Infectious Diseases and Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
| |
Collapse
|
2
|
Carvajal LP, Rincon S, Gomez-Villegas SI, Matiz-González JM, Ordoñez K, Santamaria A, Ospina-Navarro L, Beltran J, Guevara F, Mendez YR, Salcedo S, Porras A, Valencia-Moreno A, Grennia H, Deyanov A, Baptista R, Tam VH, Panesso D, Tran TT, Miller WR, Arias CA, Reyes J. Prevalence of the Cefazolin Inoculum Effect (CzIE) in Nasal Colonizing Methicillin-Susceptible Staphylococcus aureus in Patients from Intensive Care Units in Colombia and Use of a Modified Rapid Nitrocefin Test for Detection. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.11.24309236. [PMID: 39040169 PMCID: PMC11261917 DOI: 10.1101/2024.07.11.24309236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
The cefazolin inoculum effect (CzIE) has been associated with poor clinical outcomes in patients with MSSA infections. We aimed to investigate the point prevalence of the CzIE among nasal colonizing MSSA isolates from ICU patients in a multicenter study in Colombia (2019-2023). Patients underwent nasal swabs to assess for S. aureus colonization on admission to the ICU and some individuals had follow-up swabs. We performed cefazolin MIC by broth-microdilution using standard and high-inoculum and developed a modified nitrocefin-based rapid test to detect the CzIE. Whole genome sequencing was carried out to characterize BlaZ types and allotypes, phylogenomics and Agr-typing. All swabs were subjected to 16S-rRNA metabarcoding sequencing to evaluate microbiome characteristics associated with the CzIE. A total of 352 patients were included; 46/352 (13%) patients were colonized with S. aureus; 22% (10/46) and 78% (36/46) with MRSA and MSSA, respectively. Among 36 patients that contributed with 43 MSSA colonizing isolates, 21/36 (58%) had MSSA exhibiting the CzIE. BlaZ type A and BlaZ-2 were the predominant type and allotype in 56% and 52%, respectively. MSSA belonging to CC30 were highly associated with the CzIE and SNP analyses supported transmission of MSSA exhibiting the CzIE among some patients of the same unit. The modified nitrocefin rapid test had 100%, 94.4% and 97.7% sensitivity, specificity and accuracy, respectively. We found a high prevalence point prevalence of the CzIE in MSSA colonizing the nares of critically-ill patients in Colombia. A modified rapid test was highly accurate in detecting the CzIE in this patient population.
Collapse
Affiliation(s)
- Lina P. Carvajal
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
| | - Sandra Rincon
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
| | | | - Juan M. Matiz-González
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
| | - Karen Ordoñez
- Department of Infectious Diseases, ESE Hospital Universitario, San Jorge de Pereira, Pereira, Colombia
| | - Alejandra Santamaria
- Department of Infectious Diseases, ESE Hospital Universitario, San Jorge de Pereira, Pereira, Colombia
| | | | | | - Fredy Guevara
- Servicio de Infectología, Fundación Santafe de Bogota, Bogota, Colombia
- Clinica Reina Sofia, Colsanitas, Bogota, Colombia
| | - Yardany R. Mendez
- Grupo de Investigacion en Epidemiologia Clinica de Colombia (GRECO), Universidad Pedagogica y Tecnologica de Colombia, Tunja, Colombia
- Hospital Regional de Duitama, Duitama, Colombia
| | - Soraya Salcedo
- Organizacion Clinica General del Norte, Barranquilla, Colombia
| | | | | | - Haley Grennia
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, TX USA
| | - Alexander Deyanov
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, TX USA
| | - Rodrigo Baptista
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, TX USA
- Division of Infectious Diseases and Department of Medicine, Houston Methodist Hospital, Houston, TX USA 77030
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Vincent H. Tam
- Departament of Pharmacy Practice and Translational Research, University of Houston, Houston, Texas, United States
| | - Diana Panesso
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, TX USA
- Division of Infectious Diseases and Department of Medicine, Houston Methodist Hospital, Houston, TX USA 77030
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Truc T. Tran
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, TX USA
- Division of Infectious Diseases and Department of Medicine, Houston Methodist Hospital, Houston, TX USA 77030
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - William R. Miller
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, TX USA
- Division of Infectious Diseases and Department of Medicine, Houston Methodist Hospital, Houston, TX USA 77030
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Cesar A. Arias
- Center for Infectious Disease, Houston Methodist Research Institute, Houston, TX USA
- Division of Infectious Diseases and Department of Medicine, Houston Methodist Hospital, Houston, TX USA 77030
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
| |
Collapse
|
3
|
Lo CKF, Sritharan A, Zhang J, Li N, Zhang C, Wang F, Loeb M, Bai AD. Clinical significance of cefazolin inoculum effect in serious MSSA infections: a systematic review. JAC Antimicrob Resist 2024; 6:dlae069. [PMID: 38716403 PMCID: PMC11073751 DOI: 10.1093/jacamr/dlae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/10/2024] [Indexed: 06/29/2024] Open
Abstract
Background The cefazolin inoculum effect (CzIE) is a phenomenon whereby some MSSA isolates demonstrate resistance to cefazolin when a high bacterial inoculum is used for susceptibility testing. The clinical significance of this phenotypic phenomenon remains unclear. We conducted a systematic review to answer the following question: In patients with serious MSSA infection treated with cefazolin, does infection due to CzIE-positive MSSA isolates result in worse clinical outcomes than infection due to CzIE-negative MSSA isolates? Methods Ovid MEDLINE, Embase, Cochrane CENTRAL, medRxiv and bioRxiv were searched from inception until 12 April 2023. Studies were included if they tested for CzIE in clinical isolates from MSSA infections in humans. Two independent reviewers extracted data and conducted risk-of-bias assessment. Main outcomes were treatment failure and mortality. Pooling of study estimates was not performed given the heterogeneity of patient populations and outcome definitions. Results Twenty-three observational studies were included. CzIE presence amidst MSSA isolates ranged from 0% to 55%. There was no statistically significant mortality difference in two studies that compared MSSA infections with and without CzIE, with ORs ranging from 0.72 to 19.78. Of four studies comparing treatment failure, ORs ranged from 0.26 to 13.00. One study showed a significantly higher treatment failure for the CzIE group, but it did not adjust for potential confounders. Conclusions The evidence on CzIE is limited by small observational studies. In these studies, CzIE did not predict higher mortality in MSSA infections treated with cefazolin. Our findings do not support CzIE testing in clinical practice currently.
Collapse
Affiliation(s)
- Calvin Ka-Fung Lo
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ashwin Sritharan
- Michael G. DeGroote Undergraduate School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jiesi Zhang
- Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Nicole Li
- Faculty of Arts and Sciences, Queen's University, Kingston, ON, Canada
| | - Cindy Zhang
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Frank Wang
- Michael G. DeGroote Undergraduate School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Anthony D Bai
- Division of Infectious Diseases, Department of Medicine, Queen’s University, Kingston, ON, Canada
| |
Collapse
|
4
|
Svishchuk J, Ebbert K, Waddell B, Izydorczyk C, Acosta N, Somayaji R, Rabin HR, Bjornson CL, Lisboa L, Gregson DB, Conly JM, Surette MG, Parkins MD. Epidemiology and impact of methicillin-sensitive Staphylococcus aureus with β-lactam antibiotic inoculum effects in adults with cystic fibrosis. Antimicrob Agents Chemother 2023; 67:e0013623. [PMID: 37966229 PMCID: PMC10720481 DOI: 10.1128/aac.00136-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/22/2023] [Indexed: 11/16/2023] Open
Abstract
Staphylococcus aureus is the most prevalent cystic fibrosis (CF) pathogen. Several phenotypes are associated with worsened CF clinical outcomes including methicillin-resistance and small-colony-variants. The inoculum effect (IE) is characterized by reduced β-lactam susceptibility when assessed at high inoculum. The IE associates with worse outcomes in bacteremia and other high-density infections, and may therefore be relevant to CF. The prevalence of IE amongst a CF cohort (age ≥18 years), followed from 2013 to 2016, was investigated. Yearly methicillin-sensitive S. aureus (MSSA) isolates were screened at standard (5 × 105 CFU/mL) and high (5 × 107 CFU/mL) inoculum against narrow-spectrum anti-Staphylococcal β-lactams and those with anti-pseudomonal activity common to CF. A ≥ 4-fold increase in minimum inhibitory concentration between standard and high inoculum defined IE. Isolates underwent blaZ sequencing and genotyping and were compared against published genomes. Fifty-six percent (99/177) of individuals had MSSA infection. MSSA was observed at ≥105 CFU/mL in 44.8% of entry sputum samples. The prevalence of the IE was 25.0%-cefazolin; 13.5%-cloxacillin; 0%-meropenem; 1.0%-cefepime; 5.2%-ceftazidime; and 34.4%-piperacillin-tazobactam amongst baseline MSSA isolates assessed. blaZ A associated with cefazolin IE (P = 0.0011), whereas blaZ C associated with piperacillin-tazobactam IE (P < 0.0001). Baseline demographics did not reveal specific risk factors for IE-associated infections, nor were long-term outcomes different. Herein, we observed the IE in CF-derived MSSA disproportionally for cefazolin and piperacillin-tazobactam and this phenotype strongly associated with underlying blaZ genotype. The confirmation of CF being a high density infection, and the identification of high prevalence of MSSA with IE in CF supports the need for prospective pulmonary exacerbation treatment studies to understand the impact of this phenotype.
Collapse
Affiliation(s)
- J. Svishchuk
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - K. Ebbert
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - B. Waddell
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - C. Izydorczyk
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - N. Acosta
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - R. Somayaji
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - H. R. Rabin
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - C. L. Bjornson
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - L. Lisboa
- Department of Pathology and Laboratory Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - D. B. Gregson
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - J. M. Conly
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - M. G. Surette
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - M. D. Parkins
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| |
Collapse
|
5
|
George CRR, Lahra MM, Nguyen T, Gatus B. Disc Test for Detecting Staphylococcus aureus Strains Producing Type A and Type C β-Lactamases. Microbiol Spectr 2023; 11:e0022023. [PMID: 37409947 PMCID: PMC10434206 DOI: 10.1128/spectrum.00220-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/22/2023] [Indexed: 07/07/2023] Open
Abstract
Staphylococcus aureus can produce β-lactamases capable of hydrolyzing penicillins and first-generation cephalosporins. The propensity of type A and type C β-lactamase-producing S. aureus (TAPSA and TCPSA) to hydrolyze cefazolin at a high inoculum is termed the cefazolin inoculum effect (CIE). Strains with a CIE have a theoretical risk of causing treatment failure and are unable to be detected routinely by most laboratories. We developed a high-performing yet straightforward β-lactamase disc test that identifies and differentiates both TAPSA and TCPSA and is suitable for routine diagnostic laboratory workflows. Clinical isolates of S. aureus resistant to penicillin were identified, and their blaZ genes were sequenced. MICs were determined at low and high inocula (5 × 105 CFU/mL and 5 × 107 CFU/mL), and isolates demonstrating a CIE were characterized. A semimechanistic model was established to describe differential hydrolysis patterns, and candidate models were iteratively assessed using area-under-the-curve analysis from competitor receiver operating characteristic (ROC) curves. Biomarker thresholds were derived from Youdon index-derived optimal cutoff values. Genetic analysis of 99 isolates identified 26 TAPSA isolates and 45 TCPSA isolates. The model best differentiating TAPSA from non-TAPSA utilized cefazolin-to-cephalothin ratio analysis (sensitivity, 96.2%; specificity, 98.6%). The model best differentiating TCPSA from non-TCPSA incorporated cefazolin, cephalothin, and oxacillin (sensitivity, 88.6%; specificity, 96.6%). TAPSA and TCPSA can be differentiated using three antibiotic discs on a single agar plate. The test has potential value in typing the β-lactamase type from isolates from patients that are candidates for or have failed cefazolin therapy. IMPORTANCE The key significance of this article is that it details a straightforward method of performing a disc test that can differentiate Staphylococcus aureus isolates that are likely to be associated with a cefazolin inoculum effect and theoretical risk of cefazolin treatment failure from isolates that are less likely to be associated with a cefazolin inoculum effect.
Collapse
Affiliation(s)
- C. R. Robert George
- NSW Health Pathology, Microbiology, John Hunter Hospital, Newcastle, Australia
| | - Monica M. Lahra
- NSW Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, Australia
- School of Medical Sciences, Faculty of Medicine, the University of New South Wales, Sydney, Australia
| | - Thanh Nguyen
- NSW Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, Australia
| | - Barrie Gatus
- NSW Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, Australia
- School of Medical Sciences, Faculty of Medicine, the University of New South Wales, Sydney, Australia
| |
Collapse
|
6
|
Bourreau A, Le Mabecque V, Broquet A, Caillon J. Prevalence of a cefazolin inoculum effect associated with blaZ gene types, and clinical outcomes among methicillin-susceptible Staphylococcus aureus blood isolates of patients with infective endocarditis. Infect Dis Now 2023; 53:104626. [PMID: 36184048 DOI: 10.1016/j.idnow.2022.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/21/2022] [Accepted: 09/23/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A proportion of blaZ gene-positive methicillin-susceptible Staphylococcus aureus (MSSA) strains exhibits the cefazolin inoculum effect (CInE). Its clinical impact remains uncertain but could compromise the use of cefazolin in high-burden infections. To date, no study has been conducted in France or in Europe. We aimed to assess the prevalence of CInE and its association with blaZ beta-lactamase and S. aureus protein A (spa) types, and to assess the clinical outcomes in cefazolin-treated patients for infective endocarditis whose strain exhibited a CInE. METHODS This was a French single-center retrospective study of 51 MSSA strains from patients of the Nantes endocarditis prospective cohort, conducted between 2013 and 2018. RESULTS Cefazolin MIC50 at high inoculum was 2 mg/L (IQR 1-2). CInE was found in 17.6 % of tested strains. Among blaZ-positive strains (n = 44), type A beta-lactamase was predominant (n = 25, 57 %). Thirty-seven S. aureus protein A (spa) types were found. No statistical association was shown between blaZ or spa types and CInE. CInE was neither associated with a higher rate of persistent bacteremia (25 % vs 56.3 %, p = 0.58) nor with clinical failure in patients treated with cefazolin, in comparison to patients with no CInE strain (25 % vs 56.3 %, p = 0.58). CONCLUSION The cefazolin inoculum effect was found in a substantial number of Staphylococcus aureus strains; however, minimum inhibitory concentrations remained globally low. CInE was not associated with a higher proportion of clinical failure on treatment.
Collapse
Affiliation(s)
- A Bourreau
- Department of Infectious Diseases, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique 1413 INSERM, CHU Nantes, Nantes, France.
| | - V Le Mabecque
- Institut de RechercheenSanté de l'Université de Nantes, EA 3826-Thérapeutiques cliniques et expérimentales des infections, France
| | - A Broquet
- Institut de RechercheenSanté de l'Université de Nantes, EA 3826-Thérapeutiques cliniques et expérimentales des infections, France
| | - J Caillon
- Department of Bacteriology, CHU Hôtel-Dieu, Nantes, France
| |
Collapse
|
7
|
Dingle TC, Gamage D, Gomez-Villegas S, Hanson BM, Reyes J, Abbott A, Burnham CAD, Dien Bard J, Fritz S, Miller WR, Westblade LF, Zimmer B, Arias CA, Butler-Wu S. Prevalence and Characterization of the Cefazolin Inoculum Effect in North American Methicillin-Susceptible Staphylococcus aureus Isolates. J Clin Microbiol 2022; 60:e0249521. [PMID: 35578988 PMCID: PMC9297818 DOI: 10.1128/jcm.02495-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/03/2022] [Indexed: 02/03/2023] Open
Abstract
Antistaphylococcal penicillins and cefazolin remain the primary treatments for infections with methicillin-susceptible Staphylococcus aureus (MSSA). The cefazolin inoculum effect (CzIE) causes the cefazolin MIC to be elevated in proportion to the number of bacteria in the inoculum. The objective of this multicenter study was to evaluate the prevalence of the CzIE in North American MSSA isolates. Clinical MSSA isolates from six microbiology laboratories in the United States and one microbiology laboratory in Canada were screened for the CzIE by broth microdilution at a standard inoculum (~5 × 105 CFU/mL) and a high inoculum (~5 × 107 CFU/mL). Genome sequencing was performed to further characterize the MSSA isolates. The CzIE was present in 57/305 (18.6%) MSSA isolates, ranging from 0% to 27.9% across study sites. More of the CzIE-positive isolates (29.8%) had standard inoculum cefazolin MICs of 1.0 μg/mL than the CzIE-negative isolates did (3.2%) (P < 0.0001). Conversely, more CzIE-negative isolates (39.5%) had standard inoculum MICs of 0.25 μg/mL than the CzIE positive isolates did (5.3%) (P < 0.0001). The most common BlaZ β-lactamase types found in the CzIE-positive strains were type C (53.7%) and type A (44.4%). ST8 and ST30 were the most common sequence types among CzIE-positive isolates and correlated with BlaZ type C and A, respectively. The CzIE was present in up to a quarter of clinical MSSA isolates from North American clinical laboratories. Further studies to determine the impact of the presence of the CzIE on clinical outcomes are needed.
Collapse
Affiliation(s)
- Tanis C. Dingle
- Alberta Precision Laboratories—Public Health Laboratory, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Sara Gomez-Villegas
- Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Disease Research, Houston Methodist Research Institute, Houston, Texas, USA
| | - Blake M. Hanson
- Center for Infectious Diseases, University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas, USA
| | - Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - April Abbott
- Deaconess Health System, Evansville, Indiana, USA
| | - Carey-Ann D. Burnham
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Stephanie Fritz
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - William R. Miller
- Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
- Division of Infectious Diseases, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Lars F. Westblade
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | - Cesar A. Arias
- Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Disease Research, Houston Methodist Research Institute, Houston, Texas, USA
| | - Susan Butler-Wu
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
8
|
Staphylococcus aureus in Non-Cystic Fibrosis Bronchiectasis: Prevalence and Genomic Basis of High Inoculum Beta-Lactam Resistance. Ann Am Thorac Soc 2022; 19:1285-1293. [PMID: 35213810 DOI: 10.1513/annalsats.202108-965oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale The pathobiology of Staphylococcus aureus in non-cystic fibrosis bronchiectasis (nCFB) is poorly defined. When present at high density or "inoculum", some methicillin-sensitive S. aureus (MSSA) can inefficiently degrade anti-Staphylococcal beta-lactam antibiotics via BlaZ penicillinases (termed, the inoculum effect). Given the high burden of organisms in bronchiectatic airways, this is particularly relevant. Objectives Drawing from a prospectively-collected biobank, we sought to understand the prevalence, natural history, potential for transmission, and antibiotic resistance profiles amongst nCFB-derived MSSA isolates. Methods All individuals attending a regional consultancy nCFB clinic with sputum collected between 1981-2017 were considered, and those with ≥1 S. aureus-positive culture comprised the cohort. Each individual's most recent biobank isolate was subjected to whole genome sequencing (including the blaZ gene), antibacterial susceptibility testing, and comparative beta-lactam testing at standard (5 x 105CFU/mL) and high (5 x 107CFU/mL) inoculum to assess for the inoculum, and pronounced inoculum effect (IE and pIE, respectively). Results Seventy-four of 209 (35.4%) individuals had ≥1 sputum sample(s) with S. aureus (68 MSSA, 6 MRSA). Those with S. aureus infection were more likely to be female. Amongst 60/74 MSSA isolates subjected to WGS, no evidence of transmission was identified, although specific MLST types were prevalent including ST-1, ST-15, ST-30, and ST-45. Antibiotic resistance was uncommon except for macrolides (~20%). Amongst the 60 MSSA, prevalence of IE and pIE, respectively, were observed to be drug specific; meropenem (0%, 0%), cefepime (3%, 5%), ceftazidime (8%, 0%), cloxacillin (12%, 0%), cefazolin (23%, 0%) and piperacillin-tazobactam (37%, 17%). The cefazolin IE associated with blaZ type A (p<0.01) and ST-30 (p<0.01), whereas the piperacillin-tazobactam IE associated with type C blaZ (p<0.001) and ST-15 (p<0.05). Conclusions S. aureus infection was common, although no evidence of transmission was apparent in our nCFB cohort. While routine susceptibility testing did not identify significant resistance, inoculum-related resistance was found to be relevant for commonly used nCFB antibiotics including cefazolin and piperacillin-tazobactam. Given previous associations between IEs and negative patient outcomes, further work is warranted to understand how this phenotype impacts nCFB disease progression.
Collapse
|
9
|
Fisher JF, Mobashery S. β-Lactams against the Fortress of the Gram-Positive Staphylococcus aureus Bacterium. Chem Rev 2021; 121:3412-3463. [PMID: 33373523 PMCID: PMC8653850 DOI: 10.1021/acs.chemrev.0c01010] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The biological diversity of the unicellular bacteria-whether assessed by shape, food, metabolism, or ecological niche-surely rivals (if not exceeds) that of the multicellular eukaryotes. The relationship between bacteria whose ecological niche is the eukaryote, and the eukaryote, is often symbiosis or stasis. Some bacteria, however, seek advantage in this relationship. One of the most successful-to the disadvantage of the eukaryote-is the small (less than 1 μm diameter) and nearly spherical Staphylococcus aureus bacterium. For decades, successful clinical control of its infection has been accomplished using β-lactam antibiotics such as the penicillins and the cephalosporins. Over these same decades S. aureus has perfected resistance mechanisms against these antibiotics, which are then countered by new generations of β-lactam structure. This review addresses the current breadth of biochemical and microbiological efforts to preserve the future of the β-lactam antibiotics through a better understanding of how S. aureus protects the enzyme targets of the β-lactams, the penicillin-binding proteins. The penicillin-binding proteins are essential enzyme catalysts for the biosynthesis of the cell wall, and understanding how this cell wall is integrated into the protective cell envelope of the bacterium may identify new antibacterials and new adjuvants that preserve the efficacy of the β-lactams.
Collapse
Affiliation(s)
- Jed F Fisher
- Department of Chemistry and Biochemistry, McCourtney Hall, University of Notre Dame, Notre Dame Indiana 46556, United States
| | - Shahriar Mobashery
- Department of Chemistry and Biochemistry, McCourtney Hall, University of Notre Dame, Notre Dame Indiana 46556, United States
| |
Collapse
|
10
|
A Test for the Rapid Detection of the Cefazolin Inoculum Effect in Methicillin-Susceptible Staphylococcus aureus. J Clin Microbiol 2021; 59:JCM.01938-20. [PMID: 33536292 DOI: 10.1128/jcm.01938-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/23/2021] [Indexed: 11/20/2022] Open
Abstract
The cefazolin inoculum effect (CzIE) has been associated with therapeutic failures and mortality in invasive methicillin-susceptible Staphylococcus aureus (MSSA) infections. A diagnostic test to detect the CzIE is not currently available. We developed a rapid (∼3 h) CzIE colorimetric test to detect staphylococcal-β-lactamase (BlaZ) activity in supernatants after ampicillin induction. The test was validated using 689 bloodstream MSSA isolates recovered from Latin America and the United States. The cefazolin MIC determination at a high inoculum (107 CFU/ml) was used as a reference standard (cutoff ≥16 μg/ml). All isolates underwent genome sequencing. A total of 257 (37.3%) of MSSA isolates exhibited the CzIE by the reference standard method. The overall sensitivity and specificity of the colorimetric test was 82.5% and 88.9%, respectively. Sensitivity in MSSA isolates harboring type A BlaZ (the most efficient enzyme against cefazolin) was 92.7% with a specificity of 87.8%. The performance of the test was lower against type B and C enzymes (sensitivities of 53.3% and 72.3%, respectively). When the reference value was set to ≥32 μg/ml, the sensitivity for isolates carrying type A enzymes was 98.2%. Specificity was 100% for MSSA lacking blaZ The overall negative predictive value ranged from 81.4% to 95.6% in Latin American countries using published prevalence rates of the CzIE. MSSA isolates from the United States were genetically diverse, with no distinguishing genomic differences from Latin American MSSA, distributed among 18 sequence types. A novel test can readily identify most MSSA isolates exhibiting the CzIE, particularly those carrying type A BlaZ. In contrast to the MIC determination using high inoculum, the rapid test is inexpensive, feasible, and easy to perform. After minor validation steps, it could be incorporated into the routine clinical laboratory workflow.
Collapse
|
11
|
In Vitro Activities and Inoculum Effects of Ceftazidime-Avibactam and Aztreonam-Avibactam against Carbapenem-Resistant Enterobacterales Isolates from South Korea. Antibiotics (Basel) 2020; 9:antibiotics9120912. [PMID: 33334045 PMCID: PMC7765481 DOI: 10.3390/antibiotics9120912] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022] Open
Abstract
Ceftazidime-avibactam (CAZ-AVI) and aztreonam-avibactam (AZT-AVI) are novel antibiotic combinations active against multidrug-resistant Gram-negative pathogens. This study aimed to evaluate their in vitro activities and inoculum effects in carbapenem-resistant Enterobacterales (CRE), including carbapenemase-producing (CP)-CRE and non-CP-CRE. A total of 81 independent clinical isolates of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae were collected. CAZ-AVI and AZT-AVI minimal inhibitory concentrations (MICs) were evaluated by broth microdilution using standard and high inocula. The inoculum effect was defined as an ≥8-fold increase in MIC with high inoculum. Phenotypic determination of β-lactam resistance mechanism and PCR for carbapenemase genes were performed. Of the 81 CRE isolates, 35 (43%) were CP-CRE. Overall, 73% of the isolates were susceptible to CAZ-AVI, and 95% had low AZT-AVI MICs (≤8 µg/mL). The MIC50/MIC90s of CAZ-AVI and AZT-AVI were 4/≥512 µg/mL and 0.5/4 µg/mL, respectively. CAZ-AVI was more active against non-CP-CRE than against CP-CRE (susceptibility 80% vs. 63%, p = 0.08; MIC50/MIC90, 2/16 μg/mL vs. 4/≥512 μg/mL), whereas AZT-AVI was more active against CP-CRE (MIC50/MIC90, 0.25/1 μg/mL vs. 0.5/8 μg/mL). All four isolates with high AZT-AVI MIC (≥16 μg/mL) were resistant to CAZ-AVI, but only 18% (4/22) of CAZ-AVI-resistant isolates had high AZT-AVI MIC. The rates of the inoculum effect for CAZ-AVI and AZT-AVI were 18% and 47%, respectively (p < 0.001). Interestingly, the frequency of the AZT-AVI inoculum effect was higher in K. pneumoniae than E. coli (64% vs. 8%, p < 0.001). AZT-AVI is more active against CRE than CAZ-AVI, even in CP-CRE and CAZ-AVI-resistant isolates. The presence of a substantial inoculum effect may contribute to clinical failure in high-inoculum infections treated with AZT-AVI.
Collapse
|
12
|
Ulloa ER, Singh KV, Geriak M, Haddad F, Murray BE, Nizet V, Sakoulas G. Cefazolin and Ertapenem Salvage Therapy Rapidly Clears Persistent Methicillin-Susceptible Staphylococcus aureus Bacteremia. Clin Infect Dis 2020; 71:1413-1418. [PMID: 31773134 PMCID: PMC7486850 DOI: 10.1093/cid/ciz995] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/20/2019] [Indexed: 11/12/2022] Open
Abstract
Cefazolin and ertapenem combination therapy was used successfully to salvage 11 cases (6 endocarditis) of persistent methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, including immediate clearance (≤24 hours) in 8 cases. While in vitro synergy was modest, cefazolin plus ertapenem exhibited synergistic action in a rat model of MSSA endocarditis. The combination of cefazolin and ertapenem provides potent in vivo activity against MSSA beyond what is predicted in vitro and warrants further clinical study in the treatment of refractory MSSA bacteremia and endocarditis.
Collapse
Affiliation(s)
- Erlinda R Ulloa
- Collaborative to Halt Antibiotic-Resistant Microbes, Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California, USA
- Division of Infectious Disease, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kavindra V Singh
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | - Fadi Haddad
- Sharp Grossmont Hospital, La Mesa, California, USA
| | - Barbara E Murray
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Victor Nizet
- Collaborative to Halt Antibiotic-Resistant Microbes, Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California, USA
- Skaggs School of Pharmacy, University of California, San Diego, La Jolla, California, USA
| | - George Sakoulas
- Collaborative to Halt Antibiotic-Resistant Microbes, Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California, USA
- Sharp Memorial Hospital, San Diego, California, USA
| |
Collapse
|
13
|
Cefazolin Inoculum Effect and Methicillin-Susceptible Staphylococcus aureus Osteoarticular Infections in Children. Antimicrob Agents Chemother 2020; 64:AAC.00703-20. [PMID: 32660989 DOI: 10.1128/aac.00703-20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/28/2020] [Indexed: 12/19/2022] Open
Abstract
Select methicillin-susceptible Staphylococcus aureus (MSSA) strains may produce β-lactamases with affinity for first-generation cephalosporins (1GCs). In the setting of a high inoculum, these β-lactamases may promote the cleavage of 1GCs, a phenomenon known as the cefazolin inoculum effect (CzIE). We evaluated the prevalence and impact of CzIE on clinical outcomes among MSSA acute hematogenous osteomyelitis (AHO) cases. MSSA AHO isolates obtained from two children's hospitals between January 2011 and December 2018 were procured through ongoing surveillance studies. Isolates were tested for CzIE via a broth macrodilution assay using an inoculum of 107 CFU/ml; CzIE was defined as a cefazolin MIC of ≥16 μg/ml. Isolates were characterized by accessory gene regulator group (agr). The progression from acute to chronic osteomyelitis was considered an important outcome. A total of 250 cases with viable isolates were included. Notably, 14.4% of isolates exhibited CzIE with no observed temporal trend; and 4% and 76% of patients received a 1GC as an empirical and definitive therapy, respectively. CzIE isolates were more often resistant to clindamycin, belonged to agrIII, and associated with the development of chronic osteomyelitis. In multivariable analyses, agrIII, multiple surgical debridements, delayed source control, and CzIE were independently associated with progression to chronic osteomyelitis. A higher rate of chronic osteomyelitis was observed with CzIE isolates regardless of definitive antibiotic choice. CzIE is exhibited by 14.4% of MSSA AHO isolates in children. CzIE is independently associated with progression to chronic osteomyelitis in cases of AHO irrespective of final antibiotic choice. These data suggest that negative outcomes reported with CzIE may more accurately reflect strain-dependent virulence factors rather than true antibiotic failure.
Collapse
|
14
|
Abstract
The phenomenon of attenuated antibacterial activity at inocula above those utilized for susceptibility testing is referred to as the inoculum effect. Although the inoculum effect has been reported for several decades, it is currently debatable whether the inoculum effect is clinically significant. The aim of the present review was to consolidate currently available evidence to summarize which β-lactam drug classes demonstrate an inoculum effect against specific bacterial pathogens. Review of the literature showed that the majority of studies that evaluated the inoculum effect of β-lactams were in vitro investigations of Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Haemophilus influenzae and Staphylococcus aureus. Across all five pathogens, cephalosporins consistently displayed observable inoculum effects in vitro, whereas carbapenems were less susceptible to an inoculum effect. A handful of animal studies were available that validated that the in vitro inoculum effect translates into attenuated pharmacodynamics of β-lactams in vivo. Only a few clinical investigations were available and suggested that an in vitro inoculum effect of cefazolin against MSSA may correspond to an increased likeliness of adverse clinical outcomes in patients receiving cefazolin for bacteraemia. The presence of β-lactamase enzymes was the primary mechanism responsible for an inoculum effect, but the observation of an inoculum effect in multiple pathogens lacking β-lactamase enzymes indicates that there are likely multiple mechanisms that may result in an inoculum effect. Further clinical studies are needed to better define whether interventions made in the clinic in response to organisms displaying an in vitro inoculum effect will optimize clinical outcomes.
Collapse
Affiliation(s)
- Justin R Lenhard
- California Northstate University College of Pharmacy, Elk Grove, CA, USA
| | - Zackery P Bulman
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
15
|
Sales MJ, Sakoulas G, Szubin R, Palsson B, Arias C, Singh KV, Murray BE, Monk JM. Genome Sequence Comparison of Staphylococcus aureus TX0117 and a Beta-Lactamase-Cured Derivative Shows Increased Cationic Peptide Resistance Accompanying Mutations in relA and mnaA. Microbiol Resour Announc 2020; 9:e01515-19. [PMID: 32354985 PMCID: PMC7193940 DOI: 10.1128/mra.01515-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/26/2020] [Indexed: 11/23/2022] Open
Abstract
Staphylococcus aureus strain TX0117 is a methicillin-susceptible bacterium with type A beta-lactamase exhibiting a high cefazolin inoculum effect. TX0117 was cured of blaZ, yielding TX0117c with increased antimicrobial peptide resistance. The sequencing and genome assembly of TX0117 elucidate six mutations between TX0117 and TX0117c, including relA truncation and mnA_1 substitution.
Collapse
Affiliation(s)
- Mia Jade Sales
- Bioengineering Department, University of California San Diego, La Jolla, California, USA
| | - George Sakoulas
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Richard Szubin
- Bioengineering Department, University of California San Diego, La Jolla, California, USA
| | - Bernhard Palsson
- Bioengineering Department, University of California San Diego, La Jolla, California, USA
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Cesar Arias
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Kavindra V Singh
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Barbara E Murray
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Jonathan M Monk
- Bioengineering Department, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
16
|
Novel Insights into the Classification of Staphylococcal β-Lactamases in Relation to the Cefazolin Inoculum Effect. Antimicrob Agents Chemother 2020; 64:AAC.02511-19. [PMID: 32071048 DOI: 10.1128/aac.02511-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/10/2020] [Indexed: 12/19/2022] Open
Abstract
Cefazolin has become a prominent therapy for methicillin-susceptible Staphylococcus aureus (MSSA) infections. However, an important concern is the cefazolin inoculum effect (CzIE), a phenomenon mediated by staphylococcal β-lactamases. Four variants of staphylococcal β-lactamases have been described based on serological methodologies and limited sequence information. Here, we sought to reassess the classification of staphylococcal β-lactamases and their correlation with the CzIE. We included a large collection of 690 contemporary bloodstream MSSA isolates recovered from Latin America, a region with a high prevalence of the CzIE. We determined cefazolin MICs at standard and high inoculums by broth microdilution. Whole-genome sequencing was performed to classify the β-lactamase in each isolate based on the predicted full sequence of BlaZ. We used the classical schemes for β-lactamase classification and compared it to BlaZ allotypes found in unique sequences using the genomic information. Phylogenetic analyses were performed based on the BlaZ and core-genome sequences. The overall prevalence of the CzIE was 40%. Among 641 genomes, type C was the most predominant β-lactamase (37%), followed by type A (33%). We found 29 allotypes and 43 different substitutions in BlaZ. A single allotype, designated BlaZ-2, showed a robust and statistically significant association with the CzIE. Two other allotypes (BlaZ-3 and BlaZ-5) were associated with a lack of the CzIE. Three amino acid substitutions (A9V, E112A, and G145E) showed statistically significant association with the CzIE (P = <0.01). CC30 was the predominant clone among isolates displaying the CzIE. Thus, we provide a novel approach to the classification of the staphylococcal β-lactamases with the potential to more accurately identify MSSA strains exhibiting the CzIE.
Collapse
|
17
|
Allen JM, Bakare L, Casapao AM, Klinker K, Childs-Kean LM, Pomputius AF. Cefazolin Versus Anti-Staphylococcal Penicillins for the Treatment of Patients with Methicillin-Susceptible Staphylococcus aureus Infection: A Meta-Analysis with Trial Sequential Analysis. Infect Dis Ther 2019; 8:671-686. [PMID: 31392580 PMCID: PMC6856230 DOI: 10.1007/s40121-019-00259-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Methicillin-susceptible Staphylococcus aureus (MSSA) is a common cause of infection in humans. Beta-lactam antibiotics are the preferred agents, with anti-staphylococcal penicillins (ASPs) or the first-generation cephalosporin, cefazolin, favored by clinicians. Recent studies comparing the two strategies suggest similar outcomes between the agents. The purpose of this meta-analysis was to explore differences between cefazolin and ASPs for the treatment of MSSA infections. METHODS We performed a meta-analysis with trial sequential analysis (TSA) of observational or cohort studies using a random-effects model. Two blinded reviewers independently assessed studies for inclusion, risk of bias, and data extraction. The primary outcome was all-cause mortality. Secondary outcomes included clinical failure, infection recurrence, and antibiotic discontinuation due to adverse events. Subgroup analyses were conducted for the primary outcome by type of ASP, studies with a high percentage of deep-seated infections, and studies of low to moderate risk of bias. RESULTS After performing a comprehensive search of the literature, and screening for study inclusion, 19 studies (13,390 patients) were included in the final meta-analysis. Fifteen of the 19 studies (79%) were judged as having a low or moderate risk of bias. Use of cefazolin was associated with lower all-cause mortality [odds ratio (OR) 0.71, 95% confidence interval (CI) 0.56-0.91, p = 0.006, I2 = 28%], clinical failure (OR 0.55, 95% CI 0.41-0.74, p < 0.001, I2 = 0%), and antibiotic discontinuation due to adverse events (OR 0.25, 95% CI 0.16-0.39, p < 0.001, I2 = 23%). Infection recurrence was higher in the cefazolin patients (OR 1.41, 95% CI 1.04-1.93, p = 0.03, I2 = 0%). CONCLUSION This meta-analysis demonstrated that the use of cefazolin was associated with significant reductions in all-cause mortality, clinical failure, and discontinuation due to adverse events, but was associated with an increased risk of infection recurrence. FUNDING University of Florida Open Access Publishing Fund funded the Rapid Service Fees. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews (study ID: CRD42018106442).
Collapse
Affiliation(s)
- John M Allen
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Orlando, FL, USA.
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA.
| | - Lolade Bakare
- University of Florida College of Pharmacy, Orlando, FL, USA
| | - Anthony M Casapao
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Jacksonville, FL, USA
| | - Ken Klinker
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Lindsey M Childs-Kean
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Ariel F Pomputius
- Biomedical and Health Information Services, University of Florida Health Science Center Libraries, Gainesville, FL, USA
| |
Collapse
|
18
|
Teng Z, Guo Y, Liu X, Zhang J, Niu X, Yu Q, Deng X, Wang J. Theaflavin-3,3´-digallate increases the antibacterial activity of β-lactam antibiotics by inhibiting metallo-β-lactamase activity. J Cell Mol Med 2019; 23:6955-6964. [PMID: 31392792 PMCID: PMC6787515 DOI: 10.1111/jcmm.14580] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/27/2019] [Accepted: 07/11/2019] [Indexed: 01/16/2023] Open
Abstract
Metallo-β-lactamases (MBLs) are some of the best known β-lactamases produced by common Gram-positive and Gram-negative pathogens and are crucial factors in the rise of bacterial resistance against β-lactam antibiotics. Although many types of β-lactamase inhibitors have been successfully developed and used in clinical settings, no MBL inhibitors have been identified to date. Nitrocefin, checkerboard and time-kill assays were used to examine the enzyme behaviour in vitro. Molecular docking calculation, molecular dynamics simulation, calculation of the binding free energy and ligand-residue interaction decomposition were used for mechanistic research. The behaviour of the enzymes in vivo was investigated by a mouse infection experiment. We showed that theaflavin-3,3´-digallate (TFDG), a natural compound lacking antibacterial activities, can inhibit the hydrolysis of MBLs. In the checkerboard and time-kill assays, we observed a synergistic effect of TFDG with β-lactam antibiotics against methicillin-resistant Staphylococcus aureus BAA1717. Molecular dynamics simulations were used to identify the mechanism of the inhibition of MBLs by TFDG, and we observed that the hydrolysis activity of the MBLs was restricted by the binding of TFDG to Gln242 and Ser369. Furthermore, the combination of TFDG with β-lactam antibiotics showed effective protection in a mouse Staphylococcus aureus pneumonia model. These findings suggest that TFDG can effectively inhibit the hydrolysis activity of MBLs and enhance the antibacterial activity of β-lactam antibiotics against pathogens in vitro and in vivo.
Collapse
Affiliation(s)
- Zihao Teng
- Department of Respiratory MedicineThe First Hospital of Jilin UniversityChangchunChina
- Key Laboratory of Zoonosis Research, Ministry of Education, Institute of Zoonosis, College of Veterinary MedicineJilin UniversityChangchunChina
| | - Yan Guo
- Department of Respiratory MedicineThe First Hospital of Jilin UniversityChangchunChina
- Key Laboratory of Zoonosis Research, Ministry of Education, Institute of Zoonosis, College of Veterinary MedicineJilin UniversityChangchunChina
| | - Xingqi Liu
- Department of Respiratory MedicineThe First Hospital of Jilin UniversityChangchunChina
- Key Laboratory of Zoonosis Research, Ministry of Education, Institute of Zoonosis, College of Veterinary MedicineJilin UniversityChangchunChina
| | - Jian Zhang
- Department of Respiratory MedicineThe First Hospital of Jilin UniversityChangchunChina
- Key Laboratory of Zoonosis Research, Ministry of Education, Institute of Zoonosis, College of Veterinary MedicineJilin UniversityChangchunChina
| | - Xiaodi Niu
- Department of Respiratory MedicineThe First Hospital of Jilin UniversityChangchunChina
| | - Qinlei Yu
- Jilin Provincial Animal Disease Control CenterChangchunChina
| | - Xuming Deng
- Department of Respiratory MedicineThe First Hospital of Jilin UniversityChangchunChina
- Key Laboratory of Zoonosis Research, Ministry of Education, Institute of Zoonosis, College of Veterinary MedicineJilin UniversityChangchunChina
| | - Jianfeng Wang
- Department of Respiratory MedicineThe First Hospital of Jilin UniversityChangchunChina
- Key Laboratory of Zoonosis Research, Ministry of Education, Institute of Zoonosis, College of Veterinary MedicineJilin UniversityChangchunChina
| |
Collapse
|
19
|
Weis S, Kesselmeier M, Davis JS, Morris AM, Lee S, Scherag A, Hagel S, Pletz MW. Cefazolin versus anti-staphylococcal penicillins for the treatment of patients with Staphylococcus aureus bacteraemia. Clin Microbiol Infect 2019; 25:818-827. [PMID: 30928559 DOI: 10.1016/j.cmi.2019.03.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 03/02/2019] [Accepted: 03/09/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND For patients with bacteraemia caused by methicillin-sensitive Staphylococcus aureus anti-staphylococcal penicillins (ASPs) or cefazolin are agents of choice. While ASPs are potentially nephrotoxic, cefazolin may be less effective in some S. aureus strains due to an inoculum effect. OBJECTIVES To perform a systematic literature review and meta-analysis assessing current evidence comparing cefazolin with ASPs for patients with S. aureus bacteraemia (SAB). METHODS We searched MEDLINE, ISI Web of Science (Science Citation Index Expanded) and the Cochrane Database as well as clinicaltrials.gov from inception to 26 June 2018. All studies investigating the effects of cefazolin versus ASP in patients with methicillin-sensitive SAB were eligible for inclusion regardless of study design, publication status or language. Additional information was requested by direct author contact. A meta-analysis to estimate relative risks (RRs) with the corresponding 95% confidence intervals (CIs) was performed. Statistical heterogeneity was estimated using I2. The primary endpoint was 90-day all-cause mortality. The Newcastle-Ottawa Scale (NOS) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used for study and data quality assessment. RESULTS Fourteen non-randomized studies were included. Seven reported the primary endpoint (RR 0.71 (0.50, 1.02), low quality of evidence). Cefazolin treatment may be associated with lower 30-day mortality rates (RR 0.70 (0.54, 0.91), low quality of evidence) and less nephrotoxicity (RR 0.36 (0.21, 0.59), (low quality of evidence)). We are uncertain whether cefazolin and ASP differ regarding treatment failure/relapse as the quality of the evidence has been assessed as very low (RR of 0.84 (0.59, 1.18)). For patients with endocarditis (RR 0.71 (0.12, 4.05)) or abscesses (RR 1.17 (0.30, 4.63)), cefazolin treatment may be associated with equal 30-day and 90-day mortality (low quality of evidence). CONCLUSIONS Cefazolin seemed to be at least equally as effective as ASPs while being associated with less nephrotoxicity.
Collapse
Affiliation(s)
- S Weis
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany; Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany.
| | - M Kesselmeier
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany; Research Group Clinical Epidemiology, CSCC, Jena University Hospital, Jena, Germany
| | - J S Davis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, NT, Australia; Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia
| | - A M Morris
- Department of Medicine, Division of Infectious Diseases, Sinai Health System, University Health Network, University of Toronto, Canada
| | - S Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - A Scherag
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany; Research Group Clinical Epidemiology, CSCC, Jena University Hospital, Jena, Germany; Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - S Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - M W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| |
Collapse
|
20
|
Karchmer AW. Definitive Treatment for Methicillin-Susceptible Staphylococcus aureus Bacteremia: Data Versus a Definitive Answer? Clin Infect Dis 2019; 65:107-109. [PMID: 28379366 DOI: 10.1093/cid/cix288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/28/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adolf W Karchmer
- Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
21
|
Shi C, Xiao Y, Zhang Q, Li Q, Wang F, Wu J, Lin N. Efficacy and safety of cefazolin versus antistaphylococcal penicillins for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia: a systematic review and meta-analysis. BMC Infect Dis 2018; 18:508. [PMID: 30305037 PMCID: PMC6180622 DOI: 10.1186/s12879-018-3418-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/27/2018] [Indexed: 01/11/2023] Open
Abstract
Background Antistaphylococcal penicillins (ASPs) and cefazolin have become the most frequent choices for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) infections. However, the best therapeutic agent to treat MSSA bacteremia remains to be established. Methods We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of these two regimens for the treatment of MSSA bacteremia. PubMed, EMBASE and the Cochrane Library from inception to February 2018 were searched. The primary outcome was mortality. The secondary outcomes included treatment failure, recurrence of bacteremia, adverse effects (AEs) and discontinuation due to AEs. Data were extracted and pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results A total of ten observational studies met the inclusion criteria. The results indicate that compared to ASPs, cefazolin was associated with significant reduction in mortality (OR, 0.69; 95% CI, 0.58 to 0.82; I2 = 3.4%) and clinical failure (OR, 0.56; 95% CI, 0.37 to 0.85; I2 = 44.9%) without increasing the recurrence of bacteremia (OR, 1.12; 95% CI, 0.94 to 1.34; I2 = 0%). There were no significant differences for the risk of anaphylaxis (OR, 0.91; 95% CI, 0.36 to 2.99; I2 = 0%) or hematotoxicity (OR, 0.56; 95% CI, 0.17 to 1.88; I2 = 0%). However, nephrotoxicity (OR, 0.36; 95% CI, 0.16 to 0.81; I2 = 0%) and hepatotoxicity (OR, 0.12; 95% CI, 0.04 to 0.41; I2 = 0%) were significantly lower in the cefazolin group. Moreover, cefazolin was associated with lower probability of discontinuation due to AEs compared with the ASPs (OR, 0.24; 95% CI, 0.12 to 0.48; I2 = 18%). Conclusion The results of present study favor the application of cefazolin and should be regarded as important evidence to help make clinical decisions in choosing a treatment option for treating MSSA bacteremia. Electronic supplementary material The online version of this article (10.1186/s12879-018-3418-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Changcheng Shi
- Department of Clinical Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Clinical Pharmacy, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China
| | - Yubo Xiao
- Department of Pharmacometrics, Mosim Co., Ltd, Shanghai, China
| | - Qi Zhang
- Department of Clinical Pharmacy, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China
| | - Qingyu Li
- Department of Clinical Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fei Wang
- Department of Clinical Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Wu
- Department of Pharmacy, Hangzhou Obstetrics & Gynecology Hospital, Hangzhou, China
| | - Nengming Lin
- Department of Clinical Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China. .,Department of Clinical Pharmacy, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China. .,Department of Clinical Pharmacology, Translational Medicine Research Center, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| |
Collapse
|
22
|
Song KH, Jung SI, Lee S, Park S, Kim ES, Park KH, Park WB, Choe PG, Kim YK, Kwak YG, Kim YS, Jang HC, Kiem S, Kim HI, Kim HB. Inoculum effect of methicillin-susceptible Staphylococcus aureus against broad-spectrum beta-lactam antibiotics. Eur J Clin Microbiol Infect Dis 2018; 38:67-74. [PMID: 30269181 DOI: 10.1007/s10096-018-3392-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/21/2018] [Indexed: 11/29/2022]
Abstract
Scarce information concerning the inoculum effect (InE) of methicillin-susceptible Staphylococcus aureus (MSSA) against broad-spectrum β-lactam antibiotics is available. We investigated the InE of MSSA against ceftriaxone, cefepime, meropenem, ampicillin/sulbactam and piperacillin/tazobactam. The bacteraemic MSSA isolates were collected at ten Korean general hospitals from Sep 2013 to Mar 2015. The InE was defined if MICs of antibiotics at high inoculum (HI, ~5 × 107 CFU/ml) increased beyond the susceptible range compared to those at standard inoculum (SI, ~5 × 105 CFU/ml). All isolates were sequenced for blaZ gene typing. Among 302 MSSA isolates, 254 (84.1%) were positive for blaZ; types A, B, C and D were 13.6%, 26.8%, 43.4% and 0.3%, respectively. Mean HI MICs of all tested antibiotics were significantly increased and increases in HI MIC of piperacillin/tazobactam (HI, 48.14 ± 4.08 vs. SI, 2.04 ± 0.08 mg/L, p < 0.001) and ampicillin/sulbactam (HI, 24.15 ± 1.27 vs. SI, 2.79 ± 0.11 mg/L, p < 0.001) were most prominent. No MSSA isolates exhibited meropenem InE, and few isolates exhibited cefepime (0.3%) and ceftriaxone (2.3%) InE, whereas 43.0% and 65.9% of MSSA isolates exhibited piperacillin/tazobactam and ampicillin/sulbactam InE, respectively. About 93% of type C blaZ versus 45% of non-type C exhibited ampicillin/sulbactam InE (p < 0.001) and 88% of type C blaZ versus 9% of non-type C exhibited piperacillin/tazobactam InE (p < 0.001). A large proportion of MSSA clinical isolates, especially those positive for type C blaZ, showed marked ampicillin/sulbactam InE and piperacillin/tazobactam.
Collapse
Affiliation(s)
- Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sook-In Jung
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Shinwon Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea.
| | - Sohee Park
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyung-Hwa Park
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Medical School, Wonju, Republic of Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Yeon-Sook Kim
- Division of Infectious Diseases, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Hee-Chang Jang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea
| | - Sungmin Kiem
- Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea
| | - Hye-In Kim
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| |
Collapse
|
23
|
Prevalence of a Cefazolin Inoculum Effect Associated with blaZ Gene Types among Methicillin-Susceptible Staphylococcus aureus Isolates from Four Major Medical Centers in Chicago. Antimicrob Agents Chemother 2018; 62:AAC.00382-18. [PMID: 29891607 DOI: 10.1128/aac.00382-18] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 06/06/2018] [Indexed: 01/17/2023] Open
Abstract
The efficacy of cefazolin with high-inoculum methicillin-susceptible Staphylococcus aureus (MSSA) infections remains in question due to therapeutic failure inferred as being due to an inoculum effect (InE). This study investigated the local prevalence of a cefazolin InE (CInE) and its association with staphylococcal blaZ gene types among MSSA isolates in the Chicago area. Four medical centers in Chicago, IL, contributed MSSA isolates. Cefazolin MICs (C-MIC) were determined at 24 h by the broth microdilution method using a standard inoculum (SI; 5 × 105 CFU/ml) and a high inoculum (HI; 5 × 107 CFU/ml). The CInE was defined as (i) a ≥4-fold increase in C-MIC between SI and HI and/or (ii) a pronounced CInE, i.e., a nonsusceptible C-MIC of ≥16 μg/ml at HI. PCR was used to amplify the blaZ gene, followed by agarose gel electrophoresis and sequencing to determine the gene type. Approximately 269 MSSA isolates were included. All but one isolate were susceptible to cefazolin at SI, and 97% remained susceptible at HI. A total of 196 isolates (73%) were blaZ positive, with the blaZ types led by gene type C (40%). CInE was seen in 45 blaZ-positive isolates (23%), with 44 (22%) presenting a ≥4-fold increase in C-MIC (SI to HI) and 5 (3%) a pronounced CInE. Four of the five met both definitions of CInE, two of which expressed the type A gene. The prevalence of a pronounced CInE associated with the type A blaZ gene from MSSA isolates in Chicago is low. Our predilection for cefazolin use, even early in the management of hospitalized MSSA infections, is tenable.
Collapse
|
24
|
Monogue ML, Ortwine JK, Wei W, Eljaaly K, Bhavan KP. Nafcillin versus cefazolin for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia. J Infect Public Health 2018. [PMID: 29526442 DOI: 10.1016/j.jiph.2018.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Anti-staphylococcal penicillins have long been the first-line treatment option for methicillin-susceptible Staphylococcus aureus (MSSA) infections. Recent retrospective data comparing nafcillin and cefazolin report similar clinical efficacy despite concerns about high inoculum MSSA infections. METHODS This was a retrospective, non-inferiority, cohort study comparing treatment failure rates between nafcillin and cefazolin in patients with MSSA bacteremia from any source, other than meningitis. Multiple logistic regression was used to adjust for confounding variables. RESULTS A total of 142 patients were included in the study. The overall treatment failure rate among patients receiving cefazolin was non-inferior to nafcillin (11.3% versus 8.5%; 90% confidence interval -5.2% to 10.8%). Rates of adverse drug events were significantly higher in the nafcillin arm (19.7% versus 7%; p=0.046). After adjustment for confounding variables, no difference between treatment groups was found in treatment failure (adjusted odds ratio (OR)=1.2; 95% CI, 0.3-4.5), but nafcillin was associated with significantly higher nephrotoxicity (adjusted odds ratio (OR)=5.4; 95% CI, 1.1-26.8). CONCLUSION Cefazolin was associated with lower nephrotoxicity and similar treatment failure rates compared to nafcillin suggesting that cefazolin is an appealing first line agent for most MSSA bloodstream infections.
Collapse
Affiliation(s)
| | - Jessica K Ortwine
- Parkland Hlth. and Hosp. System, Dallas, TX, United States; University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Wenjing Wei
- Parkland Hlth. and Hosp. System, Dallas, TX, United States; University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Khalid Eljaaly
- Department of Clinical Pharmacy, King Abdulaziz University, Saudi Arabia; College of Pharmacy, University of Arizona, United States
| | - Kavita P Bhavan
- University of Texas Southwestern Medical School, Dallas, TX, United States; University of Texas Southwestern Med. Ctr., Department of Medicine, Infectious Disease, Dallas, TX, United States
| |
Collapse
|
25
|
A large retrospective cohort study of cefazolin compared with flucloxacillin for methicillin-susceptible Staphylococcus aureus bacteraemia. Int J Antimicrob Agents 2018; 52:297-300. [PMID: 29499317 DOI: 10.1016/j.ijantimicag.2018.02.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Antistaphylococcal penicillins (ASPs) are recommended as first-line treatment for invasive infections caused by methicillin-susceptible Staphylococcus aureus (MSSA). Cefazolin is an alternative option, but there is theoretical concern about its use as some MSSA strains produce beta-lactamases active against cefazolin. The study compared the outcomes in patients with MSSA infections treated with flucloxacillin and cefazolin. METHODS We analysed data from The Australia and New Zealand Co-operative Outcomes of Staphylococcal Sepsis (ANZCOSS) observational study, which included all consecutive unique episodes of Staphylococcus aureus bacteraemia from 27 hospital-based or independent microbiology laboratories from January 2007 to September 2013. In this retrospective analysis of prospectively collected data, we compared 30-day all-cause mortality in patients with MSSA bacteraemia treated with flucloxacillin to that in patients treated with cefazolin. RESULTS We included data from 7312 episodes of MSSA bacteremia and found no difference in 30-day mortality in those treated with flucloxacillin (731/6520 [11.2%, 95% CI 10.9-12.5%]) compared to cefazolin (83/792 [10.7%, 95% CI 8.4-12.8%]), OR 0.93 (95% CI 0.72-1.17). In a propensity-adjusted analysis, mortality remained non-significantly lower in the cefazolin group (aOR 0.86 [95% CI 0.65-1.14]). CONCLUSIONS This study supports the results from previous observational studies from other regions, while extending them to Australasia and to a much larger number of patients. Although this observational study indicates cefazolin is likely to have equivalent or superior outcomes to ASPs for MSSA bacteraemia, this can only be convincingly proven by a properly designed randomised controlled trial.
Collapse
|
26
|
Inoculum effect of high concentrations of methicillin-susceptible Staphylococcus aureus on the efficacy of cefazolin and other beta-lactams. J Infect Chemother 2017; 24:212-215. [PMID: 29198902 DOI: 10.1016/j.jiac.2017.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/15/2017] [Accepted: 10/30/2017] [Indexed: 11/21/2022]
Abstract
The existence of a cefazolin inoculum effect (InE) of methicillin-susceptible Staphylococcus aureus (MSSA), which is speculated to be a reason for cefazolin treatment failure in MSSA infections, is controversial. In Japan, although cefazolin is one of the therapeutic choices for patients with MSSA infection, there are few reports of this effect. Additionally, the association between InE and blaZ type in beta-lactams other than cefazolin has not been well documented. In this study, we confirmed an MSSA InE in several beta-lactams, including cefazolin, and its relationship with blaZ, using 52 MSSA isolates from blood cultures. Three isolates (5.8%) that possessed type A blaZ showed a pronounced cefazolin InE. Five isolates (9.6%) showed pronounced InE with sulbactam/ampicillin; four isolates had type C blaZ and one had type A blaZ. However, we confirmed InE in MSSA isolates with blaZ not only type A and C but also B and D. For cefotaxime, ceftriaxone, imipenem, and meropenem, regardless of the presence of blaZ, we did not observe a significant increase in MICs at a high inoculum of MSSA. Hence, our results suggest that the above four beta-lactams are good alternatives to cefazolin if InE leads to treatment failure in a patient.
Collapse
|
27
|
Tagliaferri TL, Vieira CD, de Carvalho MAR, Ladeira LCD, Magalhães PP, de Macêdo Farias L, Dos Santos SG. Phenotypic and genotypic characterization of clinically relevant bacteria isolated from dental waste and waste workers' hands, mucosas and coats. Lett Appl Microbiol 2017; 65:306-312. [PMID: 28712134 DOI: 10.1111/lam.12775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 12/14/2022]
Abstract
Infectious wastes are potential sources of pathogenic micro-organisms, which may represent a risk to the professionals who manage them. In this study, we aimed to characterize the infectious bacteria present in dental waste and waste workers. The dental waste produced over 24 h was collected and waste workers were sampled by swabbing. Isolate resistance profiles were characterized by Vitek® and PCR and biofilm formation by Congo Red agar, string test and microtitre assay. To assess similarity between the waste and the workers' samples, a random amplified polymorphic DNA test was used. Twenty-eight bacteria were identified as clinically relevant. The most frequent gene was blaTEM present in five Gram-negative micro-organisms, and one blaSHV in Klebsiella pneumoniae. All Pseudomonas aeruginosa were positive to extracellular polymeric substances formation, except one isolated from a worker. Klebsiella pneumoniae had negative results for the string test. Pseudomonas aeruginosa showed better adherence at 25°C after 48 h of incubation and K. pneumonia had the best biofilm formation at the same temperature, after 24 h. The similarity between P. aeruginosa recovered from dental waste and from workers was low, however, it is important to note that a pathogen was found on a worker's hands and that improvements in biosafety are required. SIGNIFICANCE AND IMPACT OF THE STUDY Infectious dental waste can contain clinically relevant bacteria with important resistance and biofilm profiles. These micro-organisms could be transmitted to waste workers, other professionals and patients if the principles of biosafety measures are neglected. To our knowledge, no study has ever evaluated the microbial characterization and the potential contamination risk of dental infectious waste and waste handlers. The presence of clinically relevant bacteria in the hands and nasal mucosa of waste workers highlights the need for studies in this field to clarify the risk of these pathogens in dental healthcare services, and to stress the need for an efficient waste management.
Collapse
Affiliation(s)
- T L Tagliaferri
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - C D Vieira
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - M A R de Carvalho
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - L C D Ladeira
- Nuclear Technology Development Center (CDTN), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - P P Magalhães
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - L de Macêdo Farias
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - S G Dos Santos
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| |
Collapse
|
28
|
Loubet P, Burdet C, Vindrios W, Grall N, Wolff M, Yazdanpanah Y, Andremont A, Duval X, Lescure FX. Cefazolin versus anti-staphylococcal penicillins for treatment of methicillin-susceptible Staphylococcus aureus bacteraemia: a narrative review. Clin Microbiol Infect 2017; 24:125-132. [PMID: 28698037 DOI: 10.1016/j.cmi.2017.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/27/2017] [Accepted: 07/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Anti-staphylococcal penicillins (ASPs) are recommended as first-line agents in methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia. Concerns about their safety profile have contributed to the increased use of cefazolin. The comparative clinical effectiveness and safety profile of cefazolin versus ASPs for such infections remain unclear. Furthermore, uncertainty persists concerning the use of cefazolin due to controversies over its efficacy in deep MSSA infections and its possible negative ecological impact. AIMS The aim of this narrative review was to gather and balance available data on the efficacy and safety of cefazolin versus ASPs in the treatment of MSSA bacteraemia and to discuss the potential negative ecological impact of cefazolin. SOURCES PubMed and EMBASE electronic databases were searched up to May 2017 to retrieve available studies on the topic. CONTENTS Although described in vitro and in experimental studies, the clinical relevance of the inoculum effect during cefazolin treatment of deep MSSA infections remains unclear. It appears that there is no significant difference in rate of relapse or mortality between ASPs and cefazolin for the treatment of MSSA bacteraemia but these results should be cautiously interpreted because of the several limitations of the available studies. Compared with cefazolin, there is more frequent discontinuation for adverse effects with ASP use, especially because of cutaneous and renal events. No study has evidenced any change in the gut microbiota after the use of cefazolin. IMPLICATIONS Based on currently available studies, there are no data that enable a choice to be made of one antibiotic over the other except in patients with allergy or renal impairment. This review points out the need for future prospective studies and randomized controlled trials to better address these questions.
Collapse
Affiliation(s)
- P Loubet
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - C Burdet
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Département d'épidémiologie, biostatistique et recherche clinique, Paris, France
| | - W Vindrios
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - N Grall
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Bactériologie, Paris, France
| | - M Wolff
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de réanimation médicale et infectieuse, Paris, France
| | - Y Yazdanpanah
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - A Andremont
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Bactériologie, Paris, France
| | - X Duval
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Centre d'Investigation Clinique, Paris, France
| | - F-X Lescure
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France.
| |
Collapse
|
29
|
Singh KV, Tran TT, Nannini EC, Tam VH, Arias CA, Murray BE. Efficacy of Ceftaroline against Methicillin-Susceptible Staphylococcus aureus Exhibiting the Cefazolin High-Inoculum Effect in a Rat Model of Endocarditis. Antimicrob Agents Chemother 2017; 61:e00324-17. [PMID: 28483961 PMCID: PMC5487651 DOI: 10.1128/aac.00324-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/04/2017] [Indexed: 12/16/2022] Open
Abstract
Certain Staphylococcus aureus strains exhibit an inoculum effect (InE) with cefazolin (CFZ) that has been associated with therapeutic failures in high-inoculum infections. We assessed the in vitro activities of ceftaroline (CPT), CFZ, and nafcillin (NAF) against 17 type A β-lactamase (βla)-producing, methicillin-susceptible S. aureus (MSSA) strains, including the previously reported TX0117, which exhibits the CFZ InE, and its βla-cured derivative, TX0117c. Additionally, we determined the pharmacokinetics of CPT in rats after single intramuscular doses of 20 and 40 mg/kg of body weight and evaluated the activities of CPT (40 mg/kg every 8 h [q8h]), CFZ, and NAF against TX0117 and TX0117c in a rat model of infective endocarditis. No InE was observed for CPT or NAF, whereas a marked InE was detected for CFZ (MIC, 8 to ≥128 μg/ml). CPT and NAF treatment against TX0117 resulted in mean bacterial counts of 2.3 and 2.1 log10 CFU/g in vegetations, respectively, compared to a mean of 5.9 log10 CFU/g in the CFZ-treated group (CPT and NAF versus CFZ, P = 0.001; CPT versus NAF, P = 0.9830). Both CFZ and CPT were efficacious against the βla-cured derivative, TX0117c, compared to time zero (t0) (P = <0.0001 and 0.0015, respectively). Our data reiterate the in vivo consequences of the CFZ InE and show that CPT is not affected by this phenomenon. CPT might be considered for high-inoculum infections caused by MSSA exhibiting the CFZ InE.
Collapse
Affiliation(s)
- Kavindra V Singh
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Truc T Tran
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Esteban C Nannini
- Division of Infectious Diseases, School of Medicine, Universidad Nacional de Rosario,. Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET, Rosario, Argentina
| | - Vincent H Tam
- College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Cesar A Arias
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Microbiology and Molecular Genetics, University of Texas Medical School at Houston, Houston, Texas, USA
- Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Barbara E Murray
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Microbiology and Molecular Genetics, University of Texas Medical School at Houston, Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| |
Collapse
|
30
|
Li J, Echevarria KL, Traugott KA. β-Lactam Therapy for Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Comparative Review of Cefazolin versus Antistaphylococcal Penicillins. Pharmacotherapy 2017; 37:346-360. [PMID: 28035690 DOI: 10.1002/phar.1892] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia is associated with high morbidity and mortality. Traditionally, antistaphylococcal penicillins (ASPs) have been considered the agents of choice for the treatment of MSSA bacteremia. Vancomycin has been demonstrated to have poorer outcomes in several studies and is only recommended for patients with severe penicillin allergies. Although cefazolin is considered as an alternative to the ASPs for patients with nonsevere penicillin allergies, cefazolin offers several pharmacologic advantages over ASPs, such as more convenient dosing regimens, and antimicrobial stewardship programs are increasingly using cefazolin as the preferential agent for MSSA infections as part of cost-saving initiatives. Concerns about susceptibility to hydrolysis by type A β-lactamases, particularly at high inocula seen in deep-seated infections such as endocarditis; selective pressures from unnecessary gram-negative coverage; and lack of comparative clinical data have precluded recommending cefazolin as a first-line therapy for MSSA bacteremia. Recent clinical studies, however, have suggested similar clinical efficacy but better tolerability, with lower rates of discontinuation due to adverse drug reactions, of cefazolin compared with ASPs. Other variables, such as adequate source control (e.g., intravascular catheter removal, debridement, or drainage) and enhanced pharmacodynamics through aggressive cefazolin dosing, may mitigate the role of cefazolin inoculum effect and factor into determining improved clinical outcomes. In this review, we highlight the utility of cefazolin versus ASPs in the treatment of MSSA bacteremia with a focus on clinical efficacy and safety.
Collapse
Affiliation(s)
- Julius Li
- Department of Pharmacy, Ochsner Medical Center, New Orleans, Louisiana
| | - Kelly L Echevarria
- South Texas Veterans Health Care System, San Antonio, Texas.,The University of Texas at Austin College of Pharmacy, Austin, Texas.,Pharmacotherapy Education and Research Center, University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Kristi A Traugott
- The University of Texas at Austin College of Pharmacy, Austin, Texas.,Pharmacotherapy Education and Research Center, University of Texas Health Sciences Center San Antonio, San Antonio, Texas.,Department of Pharmacy, University Health System, San Antonio, Texas
| |
Collapse
|
31
|
Wood JB, Thomsen IP, Creech CB, Newland JG. Best Practices for Treatment of Invasive Methicillin-Susceptible Staphylococcus aureus Infections: The Case for Oxacillin. J Pediatric Infect Dis Soc 2016; 5:480-482. [PMID: 27609072 DOI: 10.1093/jpids/piw052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/25/2016] [Indexed: 11/13/2022]
Affiliation(s)
- James B Wood
- Vanderbilt Vaccine Research Program, Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Isaac P Thomsen
- Vanderbilt Vaccine Research Program, Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - C Buddy Creech
- Vanderbilt Vaccine Research Program, Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jason G Newland
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| |
Collapse
|
32
|
Association between Type A blaZ Gene Polymorphism and Cefazolin Inoculum Effect in Methicillin-Susceptible Staphylococcus aureus. Antimicrob Agents Chemother 2016; 60:6928-6932. [PMID: 27572417 DOI: 10.1128/aac.01517-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/23/2016] [Indexed: 12/18/2022] Open
Abstract
Some proportion of type A blaZ gene-positive methicillin-susceptible Staphylococcus aureus strains exhibit the cefazolin inoculum effect (CIE). The type A blaZ gene was divided into two groups by single nucleotide polymorphisms (SNPs) at Ser226Pro and Cys229Tyr. The median cefazolin MICs at a high inoculum concentration were 5.69 μg/ml for the Ser-Cys group and 40.32 μg/ml for the Pro-Tyr group (P = 0.01). The SNPs at codons 226 and 229 in the amino acid sequence encoded by the blaZ gene were closely associated with the CIE.
Collapse
|
33
|
Song KH, Jung SI, Lee S, Park S, Kiem SM, Lee SH, Kwak YG, Kim YK, Jang HC, Kim YS, Kim HI, Kim CJ, Park KH, Kim NJ, Oh MD, Kim HB. Characteristics of cefazolin inoculum effect-positive methicillin-susceptible staphylococcus aureus infection in a multicentre bacteraemia cohort. Eur J Clin Microbiol Infect Dis 2016; 36:285-294. [PMID: 27714592 DOI: 10.1007/s10096-016-2799-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/19/2016] [Indexed: 11/25/2022]
Abstract
Cefazolin treatment failure has been observed in high-inoculum infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) with a cefazolin inoculum effect (CIE). However, data on the characteristics and risk factors for the acquisition of CIE-positive MSSA infection are scarce. CIE positivity was measured as an MIC ≥ 16 μg/ml with a high inoculum (∼5 × 107 CFU/ml). The blaZ gene type was assessed through sequence analysis. The clinical characteristics and risk factors for the acquisition of CIE-positive MSSA infection were assessed. The association between the antimicrobial susceptibility profile and CIE positivity was evaluated. A total of 303 MSSA bacteraemia cases and their corresponding isolates were collected from ten hospitals: 61 (20.1 %) isolates showed a positive CIE; 254 (83.8 %) were positive for the blaZ gene. No significant association was found between CIE positivity and the site of infection. Metastatic cancer (aOR 2.86, 95 % CI, 1.10-7.48) and recent (≤1 month) close contact with a chronically ill patient (aOR 4.69, 95 % CI, 1.76-12.50) were identified as significant risk factors for CIE-positive MSSA infection through multivariate analyses. Resistances to clindamycin (OR 3.55, 95 % CI, 1.62-7.80) and erythromycin (OR 5.00, 95 % CI, 2.50-9.99) were associated with CIE positivity, presenting high specificity (92.9 %) and a negative predictive value (82.3 %). CIE-positive MSSA constituted approximately one-fifth of MSSA bacteraemia cases. Although CIE positivity was not clinically discernible, CIE positivity was associated with clindamycin or erythromycin susceptibility. Therefore, our findings suggest that cefazolin can be used in the treatment of high-inoculum MSSA infection if the isolates are susceptible to clindamycin or erythromycin.
Collapse
Affiliation(s)
- K-H Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - S-I Jung
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - S Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
| | - S Park
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - S M Kiem
- Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea
| | - S H Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Y G Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Y K Kim
- Department of Internal Medicine, Yonsei University Medical School, Wonju, Republic of Korea
| | - H-C Jang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea
| | - Y-S Kim
- Division of Infectious Diseases, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - H-I Kim
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - C J Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - K-H Park
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - N J Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - M-D Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - H B Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | | |
Collapse
|
34
|
Detection and Prevalence of Penicillin-Susceptible Staphylococcus aureus in the United States in 2013. J Clin Microbiol 2016; 54:812-4. [PMID: 26763960 DOI: 10.1128/jcm.03109-15] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/05/2016] [Indexed: 11/20/2022] Open
Abstract
Using blaZ PCR as the "gold standard," the sensitivities of CLSI penicillin zone edge and nitrocefin-based tests for β-lactamase production in Staphylococcus aureus were 64.5% and 35.5%, respectively, with specificity of 99.8% for both methods. In 2013, 13.5% of 3,083 S. aureus isolates from 31 U.S. centers were penicillin susceptible.
Collapse
|
35
|
Trouillet-Assant S, Valour F, Mouton W, Martins-Simões P, Lustig S, Laurent F, Ferry T. Methicillin-susceptible strains responsible for postoperative orthopedic infection are not selected by the use of cefazolin in prophylaxis. Diagn Microbiol Infect Dis 2015; 84:266-7. [PMID: 26707070 DOI: 10.1016/j.diagmicrobio.2015.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/12/2015] [Accepted: 11/15/2015] [Indexed: 02/01/2023]
Abstract
Comparison of methicillin-susceptible Staphylococcus aureus (MSSA) isolates responsible for bone and joint infection (BJI, n=73) and nasal colonization (n=57) revealed similar prevalence of β-lactamase (blaZ) type A production, associated with cefazolin hydrolysis, suggesting that blaZ type A-carrying MSSA isolates implicated in postoperative BJI are not selected by cefazolin prophylaxis.
Collapse
Affiliation(s)
- Sophie Trouillet-Assant
- Centre International de Recherche en Infectiologie, INSERM U1111, Pathogenesis of staphylococcal infections, University of Lyon 1, Lyon, France; Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France.
| | - Florent Valour
- Centre International de Recherche en Infectiologie, INSERM U1111, Pathogenesis of staphylococcal infections, University of Lyon 1, Lyon, France; Infectious Diseases Department, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - William Mouton
- Centre International de Recherche en Infectiologie, INSERM U1111, Pathogenesis of staphylococcal infections, University of Lyon 1, Lyon, France; Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - Patrícia Martins-Simões
- Centre International de Recherche en Infectiologie, INSERM U1111, Pathogenesis of staphylococcal infections, University of Lyon 1, Lyon, France; Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - Sébastien Lustig
- Centre International de Recherche en Infectiologie, INSERM U1111, Pathogenesis of staphylococcal infections, University of Lyon 1, Lyon, France; Orthopedic Surgery Department, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- Centre International de Recherche en Infectiologie, INSERM U1111, Pathogenesis of staphylococcal infections, University of Lyon 1, Lyon, France; Department of Clinical Microbiology, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - Tristan Ferry
- Centre International de Recherche en Infectiologie, INSERM U1111, Pathogenesis of staphylococcal infections, University of Lyon 1, Lyon, France; Infectious Diseases Department, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | | |
Collapse
|