Factors Influencing Linezolid-Nonsusceptible Coagulase-Negative Staphylococci Dissemination Among Patients in the Intensive Care Unit: A Retrospective Cohort Study

Abstract

Background: The aim of the present study was to identify risk factors for linezolid-nonsusceptible coagulase-negative staphylococci (CNS) dissemination in the intensive care unit. Methods: Among the 246 patients included, 33 revealed a linezolid-nonsusceptible CNS-positive culture specimen, 68 were positive for linezolid-susceptible CNS and 145 served as controls. Isolates were characterized by phenotypic and genotypic methods to species level, susceptibility to antistaphylococcal agents and clones. Results: Among the 33 linezolid-nonsusceptible CNS patients, 29 revealed Staphylococcus epidermidis and 4 Staphylococcus capitis. All S. epidermidis strains belonged to the ST22 clone (by multilocus sequence typing), 26 carried both C2534T and T2504A and 3 strains were C2543T mutations. S. capitis strains were stratified as a common pulsed-field gel electrophoresis type and carried the G2576T mutation. Risk factors for linezolid-nonsusceptible CNS isolation were linezolid administration and mean number of linezolid-nonsusceptible CNS-positive patients in nearby beds per day. Conclusions: These results reinforce the aspect of rational antibiotic usage, but also highlight the need for strict infection control measures to prevent the dissemination of linezolid-nonsusceptible CNS.

Molecular characteristics and predictors of mortality among Gram-positive bacteria isolated from bloodstream infections in critically ill patients during a 5-year period (2012–2016)

“…Consistently with the literature, prior administration of linezolid was the only risk factor for development of infection by LR isolates [11,12,26]. Among patients with LR-CNS [11,26]. All LR S. epidermidis belonged to ST22 and carried both C2534T, T2504A; aforementioned ST and mutations were found in previous studies from our setting and other Greek and European hospitals underlying the success of that clone [11,13,26].…”

“…One-third of infections due to CNS were linezolid resistant (LR). Consistently with the literature, prior administration of linezolid was the only risk factor for development of infection by LR isolates [11,12,26]. Among patients with LR-CNS [11,26].…”

“…The high prevalence of multidrug-resistant Gram-positive cocci has led to increased use of antibiotics with enhanced anti-Gram-positive activity, such as glycopeptides, and newer ones like linezolid and daptomycin [1,9]. The use of linezolid contributed to the rise and dissemination of strains resistant to that antibiotic, especially in CNS [10][11][12][13].…”

Co-colonization by multidrug-resistant bacteria in two Greek intensive care units

“…Even though linezolid administration did not differ between the two ICUs, no linezolid-resistant CNS was isolated in ICU B, while it was isolated from 14 patients (4 %) of ICU A. These findings reinforce the results of a previous study showing that colonization pressure is a more important risk factor than linezolid administration for the dissemination of linezolid-resistant pathogens [25]. This study has some limitations.…”

Dissemination ofStaphylococcus epidermidisST22 With Stable, High-Level Resistance to Linezolid and Tedizolid in the Greek-Turkish Region (2008–2016)

“…1 The LRSE-ST22 isolates have been associated with infection and colonization cases in Spain, France, Germany, and, particularly, Greece, and most of these LRSE-ST22 arise after treatment with linezolid. [1][2][3][4][5][6][7] In this study, we aimed to characterize the first methicillin-and linezolid-resistant S. epidermidis from a patient without previous linezolid exposure in Turkey and to assess its genetic similarity to the close geographical S. epidermidis from Greece.…”