Relapse of type A beta-lactamase-producing Staphylococcus aureus native valve endocarditis during cefazolin therapy: revisiting the issue.

Abstract

Our experience with a patient with methicillin-susceptible Staphylococcus aureus aortic native valve endocarditis, who had a relapse involving fever and positive blood culture results while receiving cefazolin, led us to evaluate this organism's ability to hydrolyze cefazolin at high inocula, a previously well-documented phenomenon. Analysis of the infecting strain disclosed a high minimum inhibitory concentration of cefazolin when a large inoculum was used, as well as rapid and complete cefazolin degradation, which was associated with regrowth in a time-kill experiment. DNA sequencing of the beta-lactamase gene showed that it was identical to that of the S. aureus type A beta-lactamase, known to efficiently inactivate cefazolin. A word of caution is given regarding the use of this antibiotic for treatment of endocarditis caused by this type of S. aureus isolate.

• Authors: Esteban C Nannini, Kavindra V Singh, Barbara E Murray
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 37 Issue 9 Pg. 1194-8 (Nov 01 2003) ISSN: 1537-6591 [Electronic] United States
• PMID: 14557964 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents
• beta-Lactamases
• Cefazolin

Topics

• Anti-Bacterial Agents (therapeutic use)
• Cefazolin (therapeutic use)
• Endocarditis, Bacterial (drug therapy, microbiology)
• Humans
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Recurrence
• Staphylococcal Infections (drug therapy)
• Staphylococcus aureus (drug effects, enzymology)
• beta-Lactamases (classification, metabolism)