The cefazolin inoculum effect is associated with increased mortality in methicillin-susceptible staphylococcus aureus bacteremia

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dc.contributor.authorMiller, William R.
dc.contributor.authorSeas, Carlos
dc.contributor.authorCarvajal Ortiz, Lina Paola
dc.contributor.authorDiaz, Lorena
dc.contributor.authorEcheverri, Aura M.
dc.contributor.authorFerro, Carolina
dc.contributor.authorPorras, Paola
dc.contributor.authorLuna, Carlos
dc.contributor.authorMunita, Jose M.
dc.contributor.authorNannini, Esteban
dc.contributor.authorCarcamo, Cesar
dc.contributor.authorReyes, Jinnethe
dc.contributor.authorArias, Cesar A.
dc.contributor.orcidCarvajal Ortiz, Lina Paola [0000-0001-8301-8836]
dc.date.accessioned2020-05-18T10:35:53Z
dc.date.available2020-05-18T10:35:53Z
dc.date.issued2018
dc.description.abstractenglishBackground 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.eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.1093/ofid/ofy123
dc.identifier.issn2328-8957
dc.identifier.urihttps://hdl.handle.net/20.500.12495/2937
dc.language.isoeng
dc.publisherOxford University Pressspa
dc.publisher.journalOpen Forum Infectious Diseasesspa
dc.relation.ispartofseriesOpen Forum Infectious Diseases, 2328-8957, Vol 5, Num 6, 2018, pag 1-9spa
dc.relation.urihttps://academic.oup.com/ofid/article/5/6/ofy123/5003417
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.creativecommons2018
dc.rights.localAcceso abiertospa
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subject.decsTiazinasspa
dc.subject.decsPenicilinasspa
dc.subject.decsBacteriemia -- Mortalidadspa
dc.subject.keywordsCephalosporinsspa
dc.subject.keywordsEndocarditisspa
dc.subject.keywordsInoculum effectspa
dc.subject.keywordsMethicillin-susceptible Staphylococcus aureusspa
dc.titleThe cefazolin inoculum effect is associated with increased mortality in methicillin-susceptible staphylococcus aureus bacteremiaspa
dc.title.translatedThe cefazolin inoculum effect is associated with increased mortality in methicillin-susceptible staphylococcus aureus bacteremiaspa
dc.typearticlespa
dc.type.hasversioninfo:eu-repo/semantics/publishedVersion
dc.type.localartículospa

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