TY - JOUR
T1 - Lack of association of Staphylococcus aureus type A β-lactamase with cefazolin combined with antimicrobial spacer placement prosthetic joint infection treatment failure
AU - Shuford, Jennifer A.
AU - Piper, Kerryl E.
AU - Hein, Melanie
AU - Trampuz, Andrej
AU - Steckelberg, James M.
AU - Patel, Robin
PY - 2006/3
Y1 - 2006/3
N2 - Association of cefazolin treatment failure with type A β-lactamase- producing Staphylococcus aureus has been suggested. The prevalence of β-lactamase gene types among 23 methicillin-susceptible S. aureus (MSSA) isolates associated with prosthetic joint infection (PJI) treated with cefazolin was determined using polymerase chain reaction (PCR), and clinical and microbiologic outcomes were assessed. PCR revealed 4 isolates without blaZ, and 12 with type A, 2 with type B, and 5 with type C blaZ. Of 13 patients undergoing resection arthroplasty with subsequent reimplantation, all received antimicrobial spacer placement at resection with or without antimicrobial- impregnated polymethylmethacrylate at reimplantation. All 13 cases had tissue cultures at time of reimplantation that were negative for S. aureus and 11 had histopathology specimens showing no acute inflammation. Of 8 type A cases undergoing reimplantation, all prostheses remained in place at follow-up (median, 798 days; range, 32-927 days). We conclude that type A blaZ is common in MSSA PJI and that cefazolin therapy for blaZ MSSA PJI can be successful when combined with 2-stage reimplantation and local antimicrobial therapy.
AB - Association of cefazolin treatment failure with type A β-lactamase- producing Staphylococcus aureus has been suggested. The prevalence of β-lactamase gene types among 23 methicillin-susceptible S. aureus (MSSA) isolates associated with prosthetic joint infection (PJI) treated with cefazolin was determined using polymerase chain reaction (PCR), and clinical and microbiologic outcomes were assessed. PCR revealed 4 isolates without blaZ, and 12 with type A, 2 with type B, and 5 with type C blaZ. Of 13 patients undergoing resection arthroplasty with subsequent reimplantation, all received antimicrobial spacer placement at resection with or without antimicrobial- impregnated polymethylmethacrylate at reimplantation. All 13 cases had tissue cultures at time of reimplantation that were negative for S. aureus and 11 had histopathology specimens showing no acute inflammation. Of 8 type A cases undergoing reimplantation, all prostheses remained in place at follow-up (median, 798 days; range, 32-927 days). We conclude that type A blaZ is common in MSSA PJI and that cefazolin therapy for blaZ MSSA PJI can be successful when combined with 2-stage reimplantation and local antimicrobial therapy.
KW - Cefazolin
KW - Prosthetic joint infection
KW - Staphylococcus aureus
KW - blaZ
KW - β-Lactamase
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UR - http://www.scopus.com/inward/citedby.url?scp=33644620686&partnerID=8YFLogxK
U2 - 10.1016/j.diagmicrobio.2005.09.015
DO - 10.1016/j.diagmicrobio.2005.09.015
M3 - Article
C2 - 16466894
AN - SCOPUS:33644620686
SN - 0732-8893
VL - 54
SP - 189
EP - 192
JO - Diagnostic Microbiology and Infectious Disease
JF - Diagnostic Microbiology and Infectious Disease
IS - 3
ER -