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

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 ertap...

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Published in:Clinical infectious diseases 2020-09, Vol.71 (6), p.1413-1418
Main Authors: Ulloa, Erlinda R, Singh, Kavindra V, Geriak, Matthew, Haddad, Fadi, Murray, Barbara E, Nizet, Victor, Sakoulas, George
Format: Article
Language:English
Subjects:
and Commentaries
Animals
Anti-Bacterial Agents - therapeutic use
Bacteremia - drug therapy
Cefazolin - therapeutic use
Ertapenem
Methicillin - pharmacology
Rats
Salvage Therapy
Staphylococcal Infections - drug therapy
Staphylococcus aureus
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Summary: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. Cefazolin and ertapenem combination therapy yielded profound clinical success in 11 severe methicillin-susceptible Staphylococcus aureus infections with high bacterial densities (6 endocarditis), as demonstrated by rapid bacteremia clearance. Enhanced efficacy was also observed in a rat endocarditis model.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/ciz995