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Eur J Clin Microbiol Infect Dis. 2017 Feb;36(2):285-294. doi: 10.1007/s10096-016-2799-1. Epub 2016 Oct 6.

Characteristics of cefazolin inoculum effect-positive methicillin-susceptible staphylococcus aureus infection in a multicentre bacteraemia cohort.

Author information

1
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
2
Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea.
3
Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea. ebenezere.lee@gmail.com.
4
Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
5
Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea.
6
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
7
Department of Internal Medicine, Yonsei University Medical School, Wonju, Republic of Korea.
8
Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea.
9
Division of Infectious Diseases, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
10
Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea.
11
Ewha Woman's University Medical Center, Seoul, Republic of Korea.
12
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

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.

PMID:
27714592
DOI:
10.1007/s10096-016-2799-1
[Indexed for MEDLINE]

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