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

Title
Characteristics of cefazolin inoculum effect-positive methicillin-susceptible staphylococcus aureus infection in a multicentre bacteraemia cohort
Authors
Song, K. -H.Jung, S. -I.Lee, S.Park, S.Kiem, S. M.Lee, S. H.Kwak, Y. G.Kim, Y. K.Jang, H. -C.Kim, Y. -S.Kim, H. -I.Kim, C. J.Park, K. -H.Kim, N. J.Oh, M. -D.Kim, H. B.Korea INfect Dis KIND Study Grp
Ewha Authors
김충종
SCOPUS Author ID
김충종scopus
Issue Date
2017
Journal Title
EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES
ISSN
0934-9723JCR Link1435-4373JCR Link
Citation
vol. 36, no. 2, pp. 285 - 294
Publisher
SPRINGER
Indexed
SCI; SCIE; SCOPUS WOS scopus
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 a 16 mu g/ml with a high inoculum (similar to 5 x 10(7) 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 (a 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.
DOI
10.1007/s10096-016-2799-1
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의료원 > 의료원 > Journal papers
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