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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.
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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
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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.
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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
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Schmidt-Hellerau K, Breuninger M, Kessel J, Vehreschild MJGT, Paul G, Reusch J, Jung N, Hellmich M, Fätkenheuer G. Flucloxacillin and cefazolin for treatment of Staphylococcus aureus bloodstream infection. Infection 2024; 52:1159-1163. [PMID: 38296936 PMCID: PMC11142999 DOI: 10.1007/s15010-023-02168-8] [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: 11/14/2023] [Accepted: 12/23/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE Antistaphylococcal penicillins and cefazolin have been used as first line therapy in Methicillin-susceptible Staphylococcus aureus bloodstream infection. While efficacy of both regimens seems to be similar, the compounds may differ with regard to tolerability. This study aims to describe the clinical use of cefazolin and flucloxacillin, focussing on discontinuation or change of anti-infective agent due to adverse events. METHODS This observational prospective study was conducted at two German tertiary care centres with an internal recommendation of flucloxacillin for MSSA-BSI in one, and of cefazolin in the other centre. Adverse events were registered weekly under treatment and at a 90-day follow-up. Descriptive analysis was complemented by a propensity score analysis comparing adverse events (stratified rank-based test applied to the sum of Common Terminology Criteria for adverse events ratings per patient). RESULTS Of 71 patients included, therapy was initiated with flucloxacillin in 56 (79%), and with cefazolin in 15 (21%). The propensity score analysis indicates a statistically significant difference concerning the severity of adverse events between the treatment groups in favour of cefazolin (p = 0.019). Adverse events led to discontinuation of flucloxacillin in 7 individuals (13% of all patients receiving flucloxacillin). Clinical outcome was not different among treatment groups. CONCLUSION Using cefazolin rather than flucloxacillin as a first line agent for treatment of MSSA-BSI is supported by these clinical data.
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Affiliation(s)
- Kirsten Schmidt-Hellerau
- Department I of Internal Medicine, Infectious Diseases, Medical Faculty, University Hospital of Cologne, University of Cologne, Cologne, Germany.
| | - Marianne Breuninger
- Department I of Internal Medicine, Infectious Diseases, Medical Faculty, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Johanna Kessel
- Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Gregor Paul
- Department I of Internal Medicine, Infectious Diseases, Medical Faculty, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Jomana Reusch
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, Infectious Diseases, Medical Faculty, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, Infectious Diseases, Medical Faculty, University Hospital of Cologne, University of Cologne, Cologne, Germany
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Ghany SSHAE, Ibrahem RA, El-Gendy AO, El-Baky RMA, Mustafa A, Azmy AF. Novel synergistic interactions between monolaurin, a mono-acyl glycerol and β lactam antibiotics against Staphylococcus aureus: an in vitro study. BMC Infect Dis 2024; 24:379. [PMID: 38584271 PMCID: PMC11000382 DOI: 10.1186/s12879-024-09261-9] [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: 09/05/2023] [Accepted: 03/26/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND A major worldwide health issue is the rising frequency of resistance of bacteria.Drug combinations are a winning strategy in fighting resistant bacteria and might help in protecting the existing drugs.Monolaurin is natural compound extracted from coconut oil and has a promising antimicrobial activity against Staphylococcus.aureus. This study aims to examine the efficacy of monolaurin both individually and in combination with β-lactam antibiotics against Staphylococcus aureus isolates. METHODS Agar dilution method was used for determination of minimum inhibitory concentration (MIC) of monolaurin against S.aureus isolates. Scanning electron microscope (SEM) was used to detect morphological changes in S.aureus after treatment with monolaurin. Conventional and Real-time Polymerase chain reaction (RT-PCR) were performed to detect of beta-lactamase (blaZ) gene and its expressional levels after monolaurin treatment. Combination therapy of monolaurin and antibiotics was assessed through fractional inhibitory concentration and time-kill method. RESULTS The antibacterial activity of monolaurin was assessed on 115 S.aureus isolates, the MIC of monolaurin were 250 to 2000 µg/ml. SEM showed cell elongation and swelling in the outer membrane of S.aureus in the prescence of 1xMIC of monolaurin. blaZ gene was found in 73.9% of S.aureus isolates. RT-PCR shows a significant decrease in of blaZ gene expression at 250 and 500 µg/ml of monolaurin. Synergistic effects were detected through FIC method and time killing curve. Combination therapy established a significant reduction on the MIC value. The collective findings from the antibiotic combinations with monolaurin indicated synergism rates ranging from 83.3% to 100%.In time-kill studies, combination of monolaurin and β-lactam antibiotics produced a synergistic effect. CONCLUSION This study showed that monolaurin may be a natural antibacterial agent against S. aureus, and may be an outstanding modulator of β-lactam drugs. The concurrent application of monolaurin and β-lactam antibiotics, exhibiting synergistic effects against S. aureus in vitro, holds promise as potential candidates for the development of combination therapies that target particularly, patients with bacterial infections that are nearly incurable.
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Affiliation(s)
- Shimaa Salah Hassan Abd El Ghany
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, 62514, Egypt
- Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University, Minia, 11566, Egypt
| | - Reham A Ibrahem
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia, 61519, Egypt.
| | - Ahmed Osama El-Gendy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, 62514, Egypt
| | - Rehab Mahmoud Abd El-Baky
- Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University, Minia, 11566, Egypt
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia, 61519, Egypt
| | - Ahmad Mustafa
- Faculty of Engineering, October University for Modern Science and Arts (MSA), Giza, Egypt
| | - Ahmed Farag Azmy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, 62514, Egypt
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