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Journal of Clinical Microbiology, January 1998, p. 219-222, Vol. 36, No. 1
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Association of Borderline Oxacillin-Susceptible Strains of Staphylococcus aureus with Surgical Wound Infections

Douglas S. Kernodle,1,2,* David C. Classen,3 Charles W. Stratton,1,4 and Allen B. Kaiser1

Division of Infectious Diseases, Department of Medicine,1 and Department of Pathology,4 Vanderbilt University School of Medicine, Nashville, Tennessee 37232; Department of Veterans Affairs Medical Center, Nashville, Tennessee 372122; and Division of Infectious Diseases, Department of Medicine, LDS Hospital, Salt Lake City, Utah 841433

Received 27 June 1997/Accepted 8 October 1997

Staphylococcus aureus isolates which produce type A staphylococcal beta -lactamase have been associated with wound infections complicating the use of cefazolin prophylaxis in surgery. To further evaluate this finding, 215 wound isolates from 14 cities in the United States were characterized by antimicrobial susceptibility and beta -lactamase type and correlated with the preoperative prophylactic regimen. Borderline-susceptible S. aureus isolates of phage group 5 (BSSA-5), which produce large amounts of type A beta -lactamase and exhibit borderline susceptibility to oxacillin, comprised a greater percentage of the 120 wound isolates associated with cefazolin prophylaxis than they did of the 95 isolates associated with other prophylactic regimens (25% versus 12.6%, respectively; P < 0.05). In contrast, methicillin-resistant S. aureus isolates were distributed evenly between the two groups (8.3% versus 11.6%, respectively). In vitro assays demonstrated that cefazolin was hydrolyzed faster by BSSA-5 strains than by other beta -lactamase-producing, methicillin-susceptible strains (1.54 versus 0.50 µg/min/108 CFU, respectively; P < 0.0001). These data demonstrate that BSSA-5 strains are a distinct subpopulation of methicillin-susceptible S. aureus which frequently cause deep surgical wound infections. Cefazolin use in prophylaxis is a risk factor for BSSA-5 infection.

* Corresponding author. Mailing address: Division of Infectious Diseases, A-3310 MCN, Vanderbilt University Medical Center, Garland and 21st Ave. South, Nashville, TN 37232-2605. Phone: (615) 327-4751, ext. 5512. Fax: (615) 321-6327. E-mail: kernodds{at}ctrvax.vanderbilt.edu.

Journal of Clinical Microbiology, January 1998, p. 219-222, Vol. 36, No. 1
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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