Possible misinterpretation of penicillin susceptibility in Staphylococcus aureus blood isolate due to in vitro loss of the blaZ gene

Eur J Clin Microbiol Infect Dis. 2022 Jan;41(1):163-167. doi: 10.1007/s10096-021-04344-w. Epub 2021 Sep 16.

Abstract

We describe a case of recurrent catheter-related blood stream infections (BSI) with Staphylococcus aureus, in which the first isolate tested susceptible to penicillin, while subsequent isolates were resistant. Phenotypic susceptibility correlated with the absence/presence of the blaZ gene. The in vitro stability of penicillin resistance was investigated by subculturing single colonies. In two out of five colonies, phenotypical resistance was lost after a single subculture, which correlated with loss of the blaZ gene. This in vitro phenomenon probably resulted in a very major error in the microbiology report of the first BSI, where penicillin had been recommended as treatment.

Keywords: In vitro susceptibility testing; PSSA PRSA; Staphylococcus aureus; blaZ.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Bacteremia / drug therapy
  • Bacteremia / microbiology*
  • Bacterial Proteins / genetics*
  • Bacterial Proteins / metabolism
  • Blood / microbiology
  • Catheter-Related Infections / drug therapy
  • Catheter-Related Infections / microbiology*
  • Humans
  • Microbial Sensitivity Tests
  • Penicillin Resistance
  • Penicillins / pharmacology*
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / microbiology*
  • Staphylococcus aureus / drug effects*
  • Staphylococcus aureus / enzymology
  • Staphylococcus aureus / genetics
  • Staphylococcus aureus / metabolism
  • beta-Lactamases / genetics*
  • beta-Lactamases / metabolism

Substances

  • Anti-Bacterial Agents
  • Bacterial Proteins
  • Penicillins
  • beta-Lactamases