Cefazolin and Ertapenem Salvage Therapy Rapidly Clears Persistent Methicillin-Susceptible Staphylococcus aureus Bacteremia

Erlinda R Ulloa; Kavindra V Singh; Matthew Geriak; Fadi Haddad; Barbara E Murray; Victor Nizet; George Sakoulas

doi:10.1093/cid/ciz995

Cefazolin and Ertapenem Salvage Therapy Rapidly Clears Persistent Methicillin-Susceptible Staphylococcus aureus Bacteremia

Clin Infect Dis. 2020 Sep 12;71(6):1413-1418. doi: 10.1093/cid/ciz995.

Authors

Erlinda R Ulloa^{1

2}, Kavindra V Singh^{3

4}, Matthew Geriak⁵, Fadi Haddad⁶, Barbara E Murray^{3

4}, Victor Nizet^{1

7}, George Sakoulas^{1

5}

Affiliations

¹ Collaborative to Halt Antibiotic-Resistant Microbes, Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California, USA.
² Division of Infectious Disease, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
³ Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
⁴ Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
⁵ Sharp Memorial Hospital, San Diego, California, USA.
⁶ Sharp Grossmont Hospital, La Mesa, California, USA.
⁷ Skaggs School of Pharmacy, University of California, San Diego, La Jolla, California, USA.

Abstract

Cefazolin and ertapenem combination therapy was used successfully to salvage 11 cases (6 endocarditis) of persistent methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, including immediate clearance (≤24 hours) in 8 cases. While in vitro synergy was modest, cefazolin plus ertapenem exhibited synergistic action in a rat model of MSSA endocarditis. The combination of cefazolin and ertapenem provides potent in vivo activity against MSSA beyond what is predicted in vitro and warrants further clinical study in the treatment of refractory MSSA bacteremia and endocarditis.

Keywords: Staphylococcus aureus; bacteremia; cefazolin; endocarditis; ertapenem.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Animals
Anti-Bacterial Agents / therapeutic use
Bacteremia* / drug therapy
Cefazolin / therapeutic use
Ertapenem
Methicillin / pharmacology
Rats
Salvage Therapy
Staphylococcal Infections* / drug therapy
Staphylococcus aureus

Substances

Anti-Bacterial Agents
Ertapenem
Cefazolin
Methicillin

Abstract

Publication types

MeSH terms

Substances

Grants and funding