title: Lack of association of Staphylococcus aureus type A beta-lactamase with cefazolin combined with antimicrobial spacer placement prosthetic joint infection treatment failure.
abstract: Association of cefazolin treatment failure with type A beta-lactamase-producing Staphylococcus aureus has been suggested. The prevalence of beta-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.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Shuford
authors.forename: Kerryl E
authors.initials: KE
authors.lastname: Piper
authors.forename: Melanie
authors.initials: M
authors.lastname: Hein
authors.forename: Andrej
authors.initials: A
authors.lastname: Trampuz
authors.forename: James M
authors.initials: JM
authors.lastname: Steckelberg
authors.forename: Robin
authors.initials: R
authors.lastname: Patel
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000096:biosynthesis* / Q000145:classification; D002437:Cefazolin / Q000627:therapeutic use*; D004269:DNA, Bacterial / Q000235:genetics; D006801:Humans; D007595:Joint Prosthesis; D016133:Polymerase Chain Reaction; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D012092:Replantation; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000201:enzymology*; D017211:Treatment Failure; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000145:classification
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D004269:DNA, Bacterial; D001618:beta-Lactamases; D002437:Cefazolin