From the JMI Laboratories, North Liberty, IA.
Children's Hospital of Philadelphia, Philadelphia, PA.
Pediatr Infect Dis J. 2023 Mar 1;42(3):206-211. doi: 10.1097/INF.0000000000003799. Epub 2022 Dec 28.
Improvements in blood culture techniques and molecular-based diagnostics have led to increased recognition of Kingella kingae as an invasive human pathogen causing bacteremia, septic arthritis, osteomyelitis and endocarditis in young children. Serious disease and potentially life-threatening complications of infection due to K. kingae necessitate timely identification and appropriate antimicrobial therapy. Ceftaroline is a fifth-generation broad spectrum cephalosporin that possesses activity against Gram-negative and Gram-positive pathogens similar to third-generation cephalosporins, but also includes methicillin-resistant Staphylococcus aureus . This study reports the in vitro activity of ceftaroline and comparator agents against an international collection of K. kingae isolates.
A collection of 308 K. kingae isolates was obtained primarily from children with bacteremia, endocarditis, osteoarticular infections or from asymptomatic pediatric carriers. Isolates were tested for antibiotic susceptibility using Clinical and Laboratory Standard Institute broth microdilution methodology and screened for β-lactamase production using a nitrocefin chromogenic test.
Ceftaroline inhibited all K. kingae isolates at ≤0.06 mg/L (MIC 50/90 , 0.015/0.03 mg/L). Ceftaroline MICs were similar to results with ceftriaxone (MIC 50/90 , 0.015/0.015 mg/L), meropenem (MIC 50/90 , 0.015/0.015 mg/L) and ampicillin-sulbactam (MIC 50/90 , 0.06/0.06 mg/L). Ceftaroline MICs were slightly lower than MICs for cefuroxime and amoxicillin/clavulanate (MIC 50/90 , 0.06/0.12 mg/L). MICs were high for clindamycin (MIC 50/90 , 2/4 mg/L) and oxacillin (MIC 50/90 , 4/8 mg/L). Sixteen isolates (5.2%) yielded a positive nitrocefin test indicating production of β-lactamase; ceftaroline demonstrated equivalent MICs against β-lactamase - positive and β-lactamase - negative strains (MIC 50/90 , 0.015/0.3 mg/L).
The potent activity of ceftaroline against this large international collection of K. kingae isolates supports further clinical evaluation in children.
血液培养技术和基于分子的诊断方法的改进，使金氏金氏菌作为一种侵袭性人类病原体的认识不断提高，导致婴幼儿菌血症、化脓性关节炎、骨髓炎和心内膜炎。由于金氏金氏菌引起的严重疾病和潜在的危及生命的感染并发症需要及时识别和适当的抗菌治疗。头孢洛林是一种第五代广谱头孢菌素，对革兰氏阴性和革兰氏阳性病原体具有与第三代头孢菌素相似的活性，但也包括耐甲氧西林的金黄色葡萄球菌。本研究报告了头孢洛林和对照剂对国际金氏金氏菌分离株的体外活性。
收集了 308 株金氏金氏菌分离株，主要来自菌血症、心内膜炎、骨关节炎感染或无症状儿科携带者的儿童。使用临床和实验室标准协会肉汤微量稀释法检测抗生素敏感性，并用硝基头孢菌素显色试验筛选β-内酰胺酶的产生。
头孢洛林抑制所有金氏金氏菌分离株的浓度均≤0.06mg/L（MIC50/90，0.015/0.03mg/L）。头孢洛林的 MIC 与头孢曲松（MIC50/90，0.015/0.015mg/L）、美罗培南（MIC50/90，0.015/0.015mg/L）和氨苄西林/舒巴坦（MIC50/90，0.06/0.06mg/L）的结果相似。头孢洛林的 MIC 略低于头孢呋辛和阿莫西林/克拉维酸的 MIC（MIC50/90，0.06/0.12mg/L）。克林霉素（MIC50/90，2/4mg/L）和苯唑西林（MIC50/90，4/8mg/L）的 MIC 较高。16 株（5.2%）产生阳性硝基头孢菌素试验，表明β-内酰胺酶的产生；头孢洛林对产β-内酰胺酶和非产β-内酰胺酶的菌株具有等效的 MIC（MIC50/90，0.015/0.3mg/L）。
头孢洛林对这一大规模国际金氏金氏菌分离株的强大活性支持了在儿童中进一步的临床评估。
