Linezolid
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Emergence of drug resistance: 8 case reports In a study of 10 patients conducted between April 2018–August 2018, 8 patients [ages and sexes not stated] were described, who exhibited emergence of linezolid resistance following treatment with linezolid for vancomycinresistant enterococci (VRE) infection [route, dosage, duration of treatment to reaction onset and outcome not stated]. The patients, who had VRE, were admitted and isolated in single rooms or the cohort room. They were treated with linezolid for 11–35 days [dosages and routes not stated]. Subsequently, they developed linezolid-resistant VRE (LSVRE) bacteraemia outbreak. LRVRE isolates were tested for linezolid resistance genes and typed as possible by pairing with linezolid-susceptible VRE (LSVRE) previously isolated, using multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). Mutation analysis revealed that all the patients carried vanA gene and had the G2576T mutation in 23S rRNA. Three ST types (ST981, ST80 and ST17) and five pulsotypes (A, B, C, H and K) were identified among the LRVRE isolates. Findings suggested that all the LRVRE isolates had 23S rRNA mutation and all the patients had received linezolid before acquisition of LRVRE support de novo mutations. Based on these investigations, emergence of linezolid resistance was confirmed. The outbreak of LRVRE resolved following the introduction of contact investigation, contact precaution with single room isolation and enforced environmental cleaning. Author comment: "We found that multiclonal spread of LRVRE and de novo mutation under antibiotic selection pressure contributed to this outbreak. It appears that linezolid resistance was derived from de novo mutations at least in cases 1 and 9 because they had identical pulsotypes in LSVRE and LRVRE isolates. Findings that all the LRVRE isolates had 23S rRNA mutation and most of the patients had received linezolid before acquisition of LRVRE support de novo mutations." Jung J, et al. The pitfall of cohort isolation in an outbreak of linezolid-resistant, vancomycin-resistant enterococci. Clinical Microbiology and Infection 25: 1568-1569, No. 12, Dec 2019. Available from: URL: http://doi.org/10.1016/ 803442202 j.cmi.2019.08.014 - South Korea
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Reactions 4 Jan 2020 No. 1785
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