Background Linezolid is used to treat vancomycin-resistant enterococcal infections. Vancomycin-resistant and -susceptible Enterococcus faecalis can develop resistance to linezolid in clinical settings with high linezolid consumption. Linezolid-resistant E. faecalis (LREF) has emerged as a major nosocomial pathogen in our hospital, in which linezolid use is considerable.Aim To define risk factors and outcomes associated with LREF infections.Methods A retrospective case-control study was designed to evaluate patients admitted to Hospital Civil de Guadalajara “Fray Antonio Alcalde” from January 2014 to October 2017. Fifty patients meeting case definitions for LREF infection and 100 controls hospitalized in the same rooms and dates as the cases were included. Clinical and demographic data were collected and analyzed.Results Risk factors for LREF, included hospitalization within the previous 6 months, intensive care unit admission, previous surgery, urinary catheterization, parenteral nutrition, and acute renal disease. Multivariate analysis identified prior exposures to linezolid [odds ratio (OR, 6.7] and clindamycin (OR, 6.7), previous hospitalization (OR, 2.8), previous surgery (OR, 5.7), and parenteral nutrition (OR, 3.4) as risk factors for LREF infection. The mortality rate for cases was 18% on the LREF versus 9% for controls.Conclusion Risk factors for LREF infections include antibiotic exposures to linezolid, clindamycin, third-generation cephalosporins, meropenem, and colistin; previous hospitalization; intensive care unit admission; previous surgery; and the use of parenteral nutrition.
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