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JAC Advance Access originally published online on September 5, 2005
Journal of Antimicrobial Chemotherapy 2005 56(4):787-789; doi:10.1093/jac/dki318
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Varying linezolid susceptibility of vancomycin-resistant Enterococcus faecium isolates during therapy: a case report

Stefanie Swoboda1,*, Stefan Fritz2, Marcus E. Martignoni2, Rita A. Feldhues3, Torsten Hoppe-Tichy1, Markus W. Buchler2 and Heinrich K. Geiss3

1 Pharmacy Department, University of Heidelberg, Im Neuenheimer Feld 670, D-69120 Heidelberg, Germany; 2 Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 120, D-69120 Heidelberg, Germany; 3 Institute of Hygiene, University of Heidelberg, Im Neuenheimer Feld 670, D-69120 Heidelberg, Germany

Received 6 May 2005; returned 29 June 2005; revised 3 August 2005; accepted 12 August 2005

* Corresponding author. Tel: +49-6221-56-32320; Fax: +49-6221-56-5343; E-mail: stefanie.swoboda{at}med.uni-heidelberg.de

Objectives: Linezolid is an oxazolidinone antibiotic used in the treatment of infections caused by vancomycin-resistant enterococci. Resistance to linezolid has been associated with a G2576U mutation in domain V of the 23S rRNA.

Patient and methods: We present clinical details and susceptibility data from multiple Enterococcus faecium strains isolated from a liver transplant patient over 13 months. MICs of linezolid, vancomycin and quinupristin/dalfopristin were determined using Etest. Molecular typing was performed by pulsed-field gel electrophoresis. Domain V of the 23S rRNA gene in the vancomycin-resistant Enterococcus faecium was amplified. Linezolid concentrations were analysed by HPLC.

Results: We report the emergence of resistance to linezolid in a vancomycin-resistant Enterococcus faecium during linezolid treatment. After discontinuation of the linezolid therapy, the isolate reverted to susceptibility. However, after re-administration of linezolid the vancomycin-resistant Enterococcus faecium became resistant to linezolid again. The isolates that were resistant to linezolid had a G2576T mutation in their 23S rDNA.

Conclusion: We describe a clinical case that shows the shift of a vancomycin-resistant Enterococcus faecium from linezolid resistance to susceptibility and then back to resistance again related to linezolid therapy.

Keywords: resistance , pharmacokinetics , pharmacodynamics , liver transplantations , mutations


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