First Report of cfr -Mediated Resistance to Linezolid in Human Staphylococcal Clinical Isolates Recovered in the United States

Abstract

Linezolid resistance has dominantly been mediated by mutations in 23S rRNA or ribosomal protein L4 genes. Recently, cfr has demonstrated the ability to produce a phenotype of resistance to not only oxazolidinones, but also other antimicrobial classes (phenicols, lincosamides, pleuromutilins, and streptogramin A). We describe the first detection of cfr-mediated linezolid resistance in Staphylococcus aureus and Staphylococcus epidermidis recovered from human infection cases monitored during the 2007 LEADER Program.

Identification and characterization of cfr-positive Staphylococcus aureus isolates from community-onset infectious patients in a county hospital in China

“…The first linezolid-resistant clinical isolate was reported in an MRSA isolate in the USA (Tsiodras et al, 2001). Since then, the occurrence of linezolid-resistant staphylococci has been increasingly reported in the United States (Mendes et al, 2008;Scheetz et al, 2008), Mexico (Mendes et al, 2010a), Japan (Ikeda-Dantsuji et al, 2011), Italy (Bongiorno et al, 2010;Mendes et al, 2010b), Spain (Sánchez García et al 2010;Seral et al, 2011) and Ireland (Kelly et al, 2008).…”

“…This gene was first identified in a bovine Staphylococcus sciuri isolate (Schwarz et al, 2000), and it was subsequently detected in clinical staphylococci isolates from different countries (Mendes et al, 2008(Mendes et al, , 2010aBongiorno et al, 2010;Sánchez García et al 2010). More recently, some investigators in China reported the presence of the cfr gene in clinical staphylococci and enterococci (Cai et al, 2012;Tian et al, 2014;Chen et al, 2013;Cui et al, 2013).…”

Methicillin-Resistant Staphylococcus aureus (MRSA) in Food- Producing and Companion Animals and Food Products

“…An outbreak with HA-MRSA ST125 containing cfr, reported from a Madrid hospital in 2010 [236], was followed by reports on the emergence of nosocomial coagulase negative staphylococci containing cfr [40]. This gene was previously found in staphylococci from animals in Europe [237,238] but has also been reported in humans in Colombia and the USA [239,240]. Distribution of the cfr gene in MRSA isolates is alarming because, besides linezolid, it confers resistance to oxazolidinones, phenicols, lincosamides, streptogramin A, and pleuromutilins, including the topical antibiotic retapamulin that is used for treatment of human skin infections [239,241,242].…”

Spread of cfr gene among staphylococci conferring resistance to linezolid in a patient under treatment

“…6 Moreover, other cases of cfr-mediated linezolid resistance in S. aureus and S. epidermidis strains isolated from human infections have also been published. 4,7 Here we report a case of acquisition of linezolid resistance from MRSA that was related to the development of chloramphenicol/clindamycin resistance with the parallel isolation of one linezolid-resistant S. epidermidis strain.…”