The Cefazolin Inoculum Effect Is Associated With Increased Mortality in Methicillin-Susceptible Staphylococcus aureus Bacteremia

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dc.contributor.authorMiller, William
dc.contributor.authorSeas, Carlos
dc.contributor.authorCarvajal, Lina
dc.contributor.authorDiaz, Lorena
dc.contributor.authorEcheverri, Aura
dc.contributor.authorFerro, Carolina
dc.contributor.authorRios, Rafael
dc.contributor.authorPorras, Paola
dc.contributor.authorLuna, Carlos
dc.contributor.authorGotuzzo, Eduardo
dc.contributor.authorMunita, José
dc.contributor.authorNannini, Esteban
dc.contributor.authorCarcamo, Cesar
dc.contributor.authorReyes, Jinnethe
dc.contributor.authorArias, Cesar
dc.date.accessioned2022-06-02T18:39:41Z
dc.date.available2022-06-02T18:39:41Z
dc.date.issued2018
dc.description.abstractBackground: Recent studies have favored the use of cefazolin over nafcillin for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. The clinical influence of the cefazolin inoculum effect (CzIE) in the effectiveness of cephalosporins for severe MSSA infections has not been evaluated. Methods: We prospectively included patients from 3 Argentinian hospitals with S. aureus bacteremia. Cefazolin minimum inhibitory concentrations (MICs) were determined at standard (105 colony-forming units [CFU]/mL) and high (107 CFU/mL) inoculum. The CzIE was defined as an increase of MIC to ≥16 µg/mL when tested at high inoculum. Whole-genome sequencing was performed in all isolates. Results: A total of 77 patients, contributing 89 MSSA isolates, were included in the study; 42 patients (54.5%) had isolates with the CzIE. In univariate analysis, patients with MSSA exhibiting the CzIE had increased 30-day mortality (P = .034) and were more likely to have catheter-associated or unknown source of bacteremia (P = .033) compared with patients infected with MSSA isolates without the CzIE. No statistically significant difference between the groups was observed in age, clinical illness severity, place of acquisition (community vs hospital), or presence of endocarditis. The CzIE remained associated with increased 30-day mortality in multivariate analysis (risk ratio, 2.65; 95% confidence interval, 1.10-6.42; P = .03). MSSA genomes displayed a high degree of heterogeneity, and the CzIE was not associated with a specific lineage. Conclusions: In patients with MSSA bacteremia where cephalosporins are used as firstline therapy, the CzIE was associated with increased 30-day mortality. Clinicians should be cautious when using cefazolin as firstline therapy for these infections.es
dc.description.versionVersión publicadaes
dc.identifier.citationMiller WR, Seas C, Carvajal LP, Diaz L, Echeverri AM, Ferro C, Rios R, Porras P, Luna C, Gotuzzo E, Munita JM, Nannini E, Carcamo C, Reyes J, Arias CA. The Cefazolin Inoculum Effect Is Associated With Increased Mortality in Methicillin-Susceptible Staphylococcus aureus Bacteremia. Open Forum Infect Dis. 2018 May 23;5(6):ofy123. doi: 10.1093/ofid/ofy123es
dc.identifier.urihttps://doi.org/10.1093/ofid/ofy123es
dc.identifier.urihttp://hdl.handle.net/11447/6179
dc.language.isoenes
dc.subjectCephalosporinses
dc.subjectEndocarditises
dc.subjectInoculum effectes
dc.subjectmethicillin-susceptible Staphylococcus aureuses
dc.titleThe Cefazolin Inoculum Effect Is Associated With Increased Mortality in Methicillin-Susceptible Staphylococcus aureus Bacteremiaes
dc.typeArticlees
dcterms.sourceOpen forum infectious diseaseses

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