Diagnostic Microbiology and Infectious Disease xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Diagnostic Microbiology and Infectious Disease journal homepage: www.elsevier.com/locate/diagmicrobio
Note
Ceftriaxone susceptibility of oxacillin-susceptible Staphylococcus aureus from patients with prosthetic joint infection Kerryl E. Greenwood-Quaintance a, Peggy Kohner a, Douglas R. Osmon b, Abinash Virk b, Robin Patel a,b,⁎ a b
Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905 Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, 55905
a r t i c l e
i n f o
Article history: Received 26 January 2015 Accepted 1 March 2015 Available online xxxx Keywords: Ceftriaxone Oxacillin-susceptible Staphylococcus aureus Prosthetic joint infection
a b s t r a c t Ceftriaxone is used to treat oxacillin-susceptible S. aureus (OSSA) prosthetic joint infection (PJI). Susceptibility of ceftriaxone against OSSA has been questioned. Ceftriaxone susceptibility was determined against 100 PJI OSSA isolates. Ceftriaxone MIC90/MIC50 were 8/4 and 4/3 μg/mL by broth microdilution and Etest, respectively. Ceftriaxone susceptibility is inferable by oxacillin susceptibility. © 2015 Elsevier Inc. All rights reserved.
Infection is a leading cause of prosthetic joint failure, leading to significant morbidity and health care costs (Osmon et al., 2013). It is estimated that 1–3% of total hip and knee arthroplasties will develop infections. Staphylococcus aureus, along with coagulase-negative staphylococci, are the major organisms that cause prosthetic joint infection (PJI) (Osmon et al., 2013). Although oxacillin resistance can occur in S. aureus, a large percentage of isolates remain oxacillin susceptible. Nafcillin, oxacillin, or cefazolin is recommended by recently published Infectious Diseases Society of America (IDSA) guidelines for the treatment of oxacillin-susceptible S. aureus (OSSA) PJI (Osmon et al., 2013). The committee did not reach consensus on the use of ceftriaxone but realized that many clinicians may use ceftriaxone for the treatment of OSSA PJI due to its reported efficacy in treating this infection and the convenience of once daily dosing for outpatient administration (Guglielmo et al., 2000; Osmon et al., 2013; Wieland et al., 2012). Neither the US Food and Drug Administration (FDA) nor the Clinical and Laboratory Standards Institute (CLSI) has specific breakpoints to determine susceptibility to ceftriaxone against S. aureus, with both recommending that ceftriaxone susceptibility be inferred based on oxacillin or cefoxitin susceptibility (Clinical and Laboratory Standards Institute (CLSI), 2014). Recently, the in vitro susceptibility of ceftriaxone against OSSA has been questioned (Pickering et al., 2014), based on the use of ceftriaxone Etest strips, which are not FDA cleared for testing of staphylococci. The aim of this study was to determine the ceftriaxone MIC values of 100 OSSA isolates recovered from patients with definite PJI, defined using
⁎ Corresponding author. Tel.: +1-507-538-0579. E-mail address: [email protected] (R. Patel).
the IDSA guidelines. These OSSA isolates were collected between 2000 and 2013 and archived at −80 °C. Ceftriaxone MICs were determined by Etest (TX256 strips; bioMérieux, Marcy L'Etoile, France) and the reference broth microdilution method. Etest was performed per manufacturer's guidelines. Briefly, a lawn of growth was made on a Mueller–Hinton agar plate using a 0.5 McFarland of logarithmically growing bacteria with the Etest strip placed on top. Broth microdilution was performed according to CLSI guidelines in 0.1-mL cation-adjusted Mueller–Hinton broth with an initial inoculum of 105 CFU/mL logarithmically growing bacteria (CLSI, 2014). Etest and broth microdilution plates were incubated for 18 hours in room air at 35 °C. S. aureus ATCC 29213 was used as a control for MIC values. Oxacillin susceptibility was determined by agar dilution according to CLSI guidelines (CLSI, 2014). One hundred OSSA isolates recovered from infections of prosthetic knees (n = 55), hips (n = 34), elbows (n = 6), and shoulders (n = 5) were studied. The ceftriaxone MIC90/MIC50 was 8/4 and 4/3 μg/mL by broth microdilution and Etest, respectively (Table). Ninety-nine of the isolates had a ceftriaxone MIC value ranging from 1 to 8 μg/mL and 1 to 6 μg/mL by broth microdilution and Etest, respectively. One isolate had a ceftriaxone MIC of 32 and 24 μg/mL by broth microdilution and Etest, respectively. This isolate was mecA negative by polymerase chain reaction, and by cefoxitin disc susceptibility, its zone of inhibition, 45 mm, also supported oxacillin susceptibility. A separate collection of 110 recent clinical OSSA isolates from all sources was tested for ceftriaxone susceptibility by agar dilution according to CLSI guidelines (CLSI, 2014). The ceftriaxone MIC90/MIC50 was 4/4 μg/mL (range ≤1–8 μg/mL) by agar dilution (Table). Although there are no current staphylococcal CLSI interpretive criteria for ceftriaxone, none of our isolates would have been resistant by the 2012 CLSI breakpoint of ≥64 μg/mL (Clinical and Laboratory
http://dx.doi.org/10.1016/j.diagmicrobio.2015.03.002 0732-8893/© 2015 Elsevier Inc. All rights reserved.
Please cite this article as: Greenwood-Quaintance KE, et al, Ceftriaxone susceptibility of oxacillin-susceptible Staphylococcus aureus from patients with prosthetic joint infection, Diagn Microbiol Infect Dis (2015), http://dx.doi.org/10.1016/j.diagmicrobio.2015.03.002
2
K.E. Greenwood-Quaintance et al. / Diagnostic Microbiology and Infectious Disease xxx (2015) xxx–xxx
Table Ceftriaxone MICs by oxacillin MICs. Oxacillin MIC (μg/mL)
Ceftriaxone MIC (μg/mL)
No. of isolates
Susceptibility by Etest method, 100 PJI S. aureus isolates 2 6 1 4 1 3 3 2 1 1 24 1 6 2 4 12 3 50 2 11 1 1 ≤0.25 4 1 3 11 2 2 1 3 Susceptibility by broth microdilution method, 100 PJI S. aureus isolates 2 8 3 4 3 1 32 1 8 6 4 64 2 5 1 1 ≤0.25 8 1 4 12 2 4 Susceptibility by agar dilution method, 110 S. aureus isolates (all sources) 2 8 1 4 3 1 4 55 2 6 ≤0.25 4 32 2 10 ≤1 3
Standards Institute (CLSI), 2012). The Etest ceftriaxone MICs correlated with the reference broth microdilution method (data not shown). The ceftriaxone susceptibility of OSSA can be inferred based on the oxacillin susceptibility. References Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013;56:e1-25. Guglielmo BJ, Luber AD, Paletta Jr D, Jacobs RA. Ceftriaxone therapy for staphylococcal osteomyelitis: a review. Clin Infect Dis 2000;30:205–7. Wieland BW, Marcantoni JR, Bommarito KM, Warren DK, Marschall J. A retrospective comparison of ceftriaxone versus oxacillin for osteoarticular infections due to methicillin-susceptible Staphylococcus aureus. Clin Infect Dis 2012;54:585–90. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: twenty-fourth informational supplement, CLSI document M100-S24. Wayne, PA: CLSI; 2014. Pickering AJ, Hariri R, Harrison LH, et al. Retraction of: Pickering AJ, Hariri R, Harrison LH, et al. Common occurrence of ceftriaxone-resistant, methicillin-sensitive Staphylococcus aureus at a community teaching hospital. Clin Infect Dis 2014. http://dx.doi.org/10.1093/cid/ ciu149. (retraction, 2014). Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: twenty-second informational supplement, CLSI document M100-S22. Wayne, PA: CLSI; 2012.
Please cite this article as: Greenwood-Quaintance KE, et al, Ceftriaxone susceptibility of oxacillin-susceptible Staphylococcus aureus from patients with prosthetic joint infection, Diagn Microbiol Infect Dis (2015), http://dx.doi.org/10.1016/j.diagmicrobio.2015.03.002
Contents lists available at ScienceDirect
Diagnostic Microbiology and Infectious Disease journal homepage: www.elsevier.com/locate/diagmicrobio
Note
Ceftriaxone susceptibility of oxacillin-susceptible Staphylococcus aureus from patients with prosthetic joint infection Kerryl E. Greenwood-Quaintance a, Peggy Kohner a, Douglas R. Osmon b, Abinash Virk b, Robin Patel a,b,⁎ a b
Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905 Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, 55905
a r t i c l e
i n f o
Article history: Received 26 January 2015 Accepted 1 March 2015 Available online xxxx Keywords: Ceftriaxone Oxacillin-susceptible Staphylococcus aureus Prosthetic joint infection
a b s t r a c t Ceftriaxone is used to treat oxacillin-susceptible S. aureus (OSSA) prosthetic joint infection (PJI). Susceptibility of ceftriaxone against OSSA has been questioned. Ceftriaxone susceptibility was determined against 100 PJI OSSA isolates. Ceftriaxone MIC90/MIC50 were 8/4 and 4/3 μg/mL by broth microdilution and Etest, respectively. Ceftriaxone susceptibility is inferable by oxacillin susceptibility. © 2015 Elsevier Inc. All rights reserved.
Infection is a leading cause of prosthetic joint failure, leading to significant morbidity and health care costs (Osmon et al., 2013). It is estimated that 1–3% of total hip and knee arthroplasties will develop infections. Staphylococcus aureus, along with coagulase-negative staphylococci, are the major organisms that cause prosthetic joint infection (PJI) (Osmon et al., 2013). Although oxacillin resistance can occur in S. aureus, a large percentage of isolates remain oxacillin susceptible. Nafcillin, oxacillin, or cefazolin is recommended by recently published Infectious Diseases Society of America (IDSA) guidelines for the treatment of oxacillin-susceptible S. aureus (OSSA) PJI (Osmon et al., 2013). The committee did not reach consensus on the use of ceftriaxone but realized that many clinicians may use ceftriaxone for the treatment of OSSA PJI due to its reported efficacy in treating this infection and the convenience of once daily dosing for outpatient administration (Guglielmo et al., 2000; Osmon et al., 2013; Wieland et al., 2012). Neither the US Food and Drug Administration (FDA) nor the Clinical and Laboratory Standards Institute (CLSI) has specific breakpoints to determine susceptibility to ceftriaxone against S. aureus, with both recommending that ceftriaxone susceptibility be inferred based on oxacillin or cefoxitin susceptibility (Clinical and Laboratory Standards Institute (CLSI), 2014). Recently, the in vitro susceptibility of ceftriaxone against OSSA has been questioned (Pickering et al., 2014), based on the use of ceftriaxone Etest strips, which are not FDA cleared for testing of staphylococci. The aim of this study was to determine the ceftriaxone MIC values of 100 OSSA isolates recovered from patients with definite PJI, defined using
⁎ Corresponding author. Tel.: +1-507-538-0579. E-mail address: [email protected] (R. Patel).
the IDSA guidelines. These OSSA isolates were collected between 2000 and 2013 and archived at −80 °C. Ceftriaxone MICs were determined by Etest (TX256 strips; bioMérieux, Marcy L'Etoile, France) and the reference broth microdilution method. Etest was performed per manufacturer's guidelines. Briefly, a lawn of growth was made on a Mueller–Hinton agar plate using a 0.5 McFarland of logarithmically growing bacteria with the Etest strip placed on top. Broth microdilution was performed according to CLSI guidelines in 0.1-mL cation-adjusted Mueller–Hinton broth with an initial inoculum of 105 CFU/mL logarithmically growing bacteria (CLSI, 2014). Etest and broth microdilution plates were incubated for 18 hours in room air at 35 °C. S. aureus ATCC 29213 was used as a control for MIC values. Oxacillin susceptibility was determined by agar dilution according to CLSI guidelines (CLSI, 2014). One hundred OSSA isolates recovered from infections of prosthetic knees (n = 55), hips (n = 34), elbows (n = 6), and shoulders (n = 5) were studied. The ceftriaxone MIC90/MIC50 was 8/4 and 4/3 μg/mL by broth microdilution and Etest, respectively (Table). Ninety-nine of the isolates had a ceftriaxone MIC value ranging from 1 to 8 μg/mL and 1 to 6 μg/mL by broth microdilution and Etest, respectively. One isolate had a ceftriaxone MIC of 32 and 24 μg/mL by broth microdilution and Etest, respectively. This isolate was mecA negative by polymerase chain reaction, and by cefoxitin disc susceptibility, its zone of inhibition, 45 mm, also supported oxacillin susceptibility. A separate collection of 110 recent clinical OSSA isolates from all sources was tested for ceftriaxone susceptibility by agar dilution according to CLSI guidelines (CLSI, 2014). The ceftriaxone MIC90/MIC50 was 4/4 μg/mL (range ≤1–8 μg/mL) by agar dilution (Table). Although there are no current staphylococcal CLSI interpretive criteria for ceftriaxone, none of our isolates would have been resistant by the 2012 CLSI breakpoint of ≥64 μg/mL (Clinical and Laboratory
http://dx.doi.org/10.1016/j.diagmicrobio.2015.03.002 0732-8893/© 2015 Elsevier Inc. All rights reserved.
Please cite this article as: Greenwood-Quaintance KE, et al, Ceftriaxone susceptibility of oxacillin-susceptible Staphylococcus aureus from patients with prosthetic joint infection, Diagn Microbiol Infect Dis (2015), http://dx.doi.org/10.1016/j.diagmicrobio.2015.03.002
2
K.E. Greenwood-Quaintance et al. / Diagnostic Microbiology and Infectious Disease xxx (2015) xxx–xxx
Table Ceftriaxone MICs by oxacillin MICs. Oxacillin MIC (μg/mL)
Ceftriaxone MIC (μg/mL)
No. of isolates
Susceptibility by Etest method, 100 PJI S. aureus isolates 2 6 1 4 1 3 3 2 1 1 24 1 6 2 4 12 3 50 2 11 1 1 ≤0.25 4 1 3 11 2 2 1 3 Susceptibility by broth microdilution method, 100 PJI S. aureus isolates 2 8 3 4 3 1 32 1 8 6 4 64 2 5 1 1 ≤0.25 8 1 4 12 2 4 Susceptibility by agar dilution method, 110 S. aureus isolates (all sources) 2 8 1 4 3 1 4 55 2 6 ≤0.25 4 32 2 10 ≤1 3
Standards Institute (CLSI), 2012). The Etest ceftriaxone MICs correlated with the reference broth microdilution method (data not shown). The ceftriaxone susceptibility of OSSA can be inferred based on the oxacillin susceptibility. References Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013;56:e1-25. Guglielmo BJ, Luber AD, Paletta Jr D, Jacobs RA. Ceftriaxone therapy for staphylococcal osteomyelitis: a review. Clin Infect Dis 2000;30:205–7. Wieland BW, Marcantoni JR, Bommarito KM, Warren DK, Marschall J. A retrospective comparison of ceftriaxone versus oxacillin for osteoarticular infections due to methicillin-susceptible Staphylococcus aureus. Clin Infect Dis 2012;54:585–90. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: twenty-fourth informational supplement, CLSI document M100-S24. Wayne, PA: CLSI; 2014. Pickering AJ, Hariri R, Harrison LH, et al. Retraction of: Pickering AJ, Hariri R, Harrison LH, et al. Common occurrence of ceftriaxone-resistant, methicillin-sensitive Staphylococcus aureus at a community teaching hospital. Clin Infect Dis 2014. http://dx.doi.org/10.1093/cid/ ciu149. (retraction, 2014). Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: twenty-second informational supplement, CLSI document M100-S22. Wayne, PA: CLSI; 2012.
Please cite this article as: Greenwood-Quaintance KE, et al, Ceftriaxone susceptibility of oxacillin-susceptible Staphylococcus aureus from patients with prosthetic joint infection, Diagn Microbiol Infect Dis (2015), http://dx.doi.org/10.1016/j.diagmicrobio.2015.03.002
