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JAC Advance Access originally published online on February 13, 2008
Journal of Antimicrobial Chemotherapy 2008 61(4):901-907; doi:10.1093/jac/dkn043
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© The Author 2008. 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

Original research

An outbreak of colonization with linezolid-resistant Staphylococcus epidermidis in an intensive therapy unit

Sinéad Kelly1, Jonathan Collins1,2, Maureen Maguire3, Catriona Gowing4, Michelle Flanagan1, Maria Donnelly5 and Philip G. Murphy1,2,*

1 Department of Clinical Microbiology, The Adelaide and Meath Hospital Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland 2 Department of Clinical Microbiology, Trinity College Dublin, Dublin 1, Ireland 3 Department of Infection Control, The Adelaide and Meath Hospital Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland 4 Department of Pharmacy, The Adelaide and Meath Hospital Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland 5 Intensive Therapy Unit, The Adelaide and Meath Hospital Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland

Received 7 November 2007; returned 4 December 2007; revised 16 January 2008; accepted 16 January 2008

* Corresponding author. Tel: +353-1-4143919; Fax: +353-1-4143352; E-mail: philip.murphy{at}amnch.ie

Objectives: To report an outbreak of colonization with linezolid-resistant Staphylococcus epidermidis in an intensive therapy unit (ITU).

Methods: An outbreak of colonization with linezolid-resistant S. epidermidis affecting 16 patients in an ITU was investigated using PFGE. Environmental and staff screening was carried out as part of the investigation. Usage of linezolid in the hospital and in the ITU was reviewed. Resistant strains were screened for the presence of the G2576T mutation using PCR-RFLP genotyping. The interventions made to control the outbreak were restriction of linezolid prescription and specific infection control measures, including isolation of colonized patients and increased environmental cleaning.

Results: Linezolid-resistant S. epidermidis strains from the 16 colonized patients were genetically related. The same strain was also cultured from environmental samples in the ITU. An increase in linezolid usage in the hospital and in the ITU occurred in the 6 months prior to the emergence of the resistant strain. Infection control measures and restriction of linezolid prescription controlled the outbreak. All resistant isolates contained the G2576T mutation.

Conclusions: An outbreak of colonization with linezolid-resistant S. epidermidis occurred in the ITU in our institution. The resistant strain colonized the environment and probably spread from patient to patient. The outbreak was associated with an increase in the linezolid usage in the ITU and in the institution as a whole. Restriction of linezolid usage and infection control measures were introduced to control the outbreak. The emergence of linezolid resistance in S. epidermidis has implications for the use of linezolid as a therapeutic agent.

Keywords: oxazolidinones , antibiotic usage , Gram-positive bacteria


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