Journal Article

Relapse of Type A β-Lactamase-Producing <i>Staphylococcus aureus</i> Native Valve Endocarditis during Cefazolin Therapy: Revisiting the Issue

Esteban C. Nannini, Kavindra V. Singh and Barbara E. Murray

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 37, issue 9, pages 1194-1198
Published in print November 2003 | ISSN: 1058-4838
Published online November 2003 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/379021
Relapse of Type A β-Lactamase-Producing Staphylococcus aureus Native Valve Endocarditis during Cefazolin Therapy: Revisiting the Issue

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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 β-lactamase gene showed that it was identical to that of the S. aureus type A β-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.

Journal Article.  3284 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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