{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T08:33:49Z","timestamp":1777365229198,"version":"3.51.4"},"reference-count":68,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":50,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Western and Northern Norway Regional Health Trusts","award":["F-11639\/4800002074"],"award-info":[{"award-number":["F-11639\/4800002074"]}]},{"name":"Western and Northern Norway Regional Health Trusts","award":["HFN 1512-20"],"award-info":[{"award-number":["HFN 1512-20"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Previous reports suggest that neonatal sepsis with methicillin-resistant (MR) CoNS can be treated with first-generation cephalosporins. We have evaluated the in vitro effect of cefazolin and other antibiotics, synergy between \u03b2-lactams and aminoglycosides, and mecA expression in MR-CoNS isolates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>Antimicrobial susceptibility testing was performed in 167 CoNS isolates from 135 very preterm infants (&amp;lt;32\u2005weeks gestation) with late-onset sepsis. Microbroth dilution chequerboard assay explored antibiotic synergy. PCR detected mecA and three aminoglycoside-modifying enzyme genes. Induction experiments evaluated if exposure to cefazolin induces resistance. RT-PCR determined mecA expression in selected MR-CoNS isolates with different cefazolin\/oxacillin MICs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All CoNS isolates were susceptible to amikacin and vancomycin. Most were phenotypically resistant to gentamicin (92%) and cefoxitin (93%), and 89% carried the mecA gene. MIC90 values of cefazolin and oxacillin were 16\u2005mg\/L and &amp;gt;256\u2005mg\/L, respectively. At the cefazolin breakpoint of 8\u2005mg\/L, 83% of isolates were susceptible in vitro. No antibiotic combinations showed synergy using the FIC index, but cefazolin combined with aminoglycosides had favourable susceptibility breakpoint index values. In a simplified synergy screen of \u2018highly resistant\u2019 isolates, growth was inhibited with a combination of gentamicin and cefazolin at sub-MIC concentrations in 8\/42 (19%) isolates. Exposure to cefazolin sub-MICs caused reduced susceptibility in 1\/30 (3%) tested isolates. The highest mecA expression was observed in isolates with high oxacillin\/cefazolin MICs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CoNS isolates had lower MICs for cefazolin than oxacillin, and 83% were in vitro susceptible to cefazolin. A clinical trial comparing cefazolin with vancomycin as empirical therapy for suspected neonatal sepsis is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jacamr\/dlag058","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T12:48:07Z","timestamp":1776430087000},"source":"Crossref","is-referenced-by-count":0,"title":["CoNS blood culture isolates from very preterm infants: antibiotic susceptibility, synergy testing and\n                    <i>mecA<\/i>\n                    gene expression"],"prefix":"10.1093","volume":"8","author":[{"given":"Zuzana","family":"Huncikova","sequence":"first","affiliation":[{"name":"Paediatric Department, Stavanger University Hospital , Stavanger ,","place":["Norway"]},{"name":"Department of Clinical Science, University of Bergen , Bergen ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin O","family":"Christensen","sequence":"additional","affiliation":[{"name":"Research Group for Child and Adolescent Health, Department of Clinical Medicine, UiT-The Arctic University of Norway , Troms\u00f8 ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Runa","family":"Wolden","sequence":"additional","affiliation":[{"name":"Research Group for Child and Adolescent Health, Department of Clinical Medicine, UiT-The Arctic University of Norway , Troms\u00f8 ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hermoine J","family":"Venter","sequence":"additional","affiliation":[{"name":"Research Group for Child and Adolescent Health, Department of Clinical Medicine, UiT-The Arctic University of Norway , Troms\u00f8 ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karianne Wiger","family":"Gammelsrud","sequence":"additional","affiliation":[{"name":"Microbiology Department, Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Medical Faculty, Institute for Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f8rgen V","family":"Bj\u00f8rnholt","sequence":"additional","affiliation":[{"name":"Microbiology Department, Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Medical Faculty, Institute for Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth G Aarag","family":"Fredheim","sequence":"additional","affiliation":[{"name":"MicroPop Research Group, Department of Pharmacy, Faculty of Health Sciences, UiT-The Arctic University of Norway , Troms\u00f8 ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dag Harald","family":"Skutlaberg","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Haukeland University Hospital , Bergen ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Einar","family":"Nilsen","sequence":"additional","affiliation":[{"name":"Department of Microbiology, M\u00f8re and Romsdal Health Trust , Molde ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kjersti Wik","family":"Larssen","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, St Olav University Hospital , Trondheim ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidi J","family":"Espvik","sequence":"additional","affiliation":[{"name":"Microbiology Department, Akershus University Hospital , Oslo ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gunnar Skov","family":"Simonsen","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Infection Control, University Hospital of North Norway , Troms\u00f8 ,","place":["Norway"]},{"name":"Research Group for Host-Microbe Interaction, Department of Medical Biology, Faculty of Health Sciences, UiT-The Arctic University of Norway , Troms\u00f8 ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arild","family":"R\u00f8nnestad","sequence":"additional","affiliation":[{"name":"Medical Faculty, Institute for Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]},{"name":"Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorunn Pauline","family":"Cavanagh","sequence":"additional","affiliation":[{"name":"Research Group for Child and Adolescent Health, Department of Clinical Medicine, UiT-The Arctic University of Norway , Troms\u00f8 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