JAC Advance Access originally published online on August 4, 2006
Journal of Antimicrobial Chemotherapy 2006 58(4):899-900; doi:10.1093/jac/dkl325
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Correspondence |
Comment on: Linezolid resistance in coagulase-negative staphylococci2
1 JMI Laboratories, North Liberty IA, USA 2 Tufts University School of Medicine Boston, MA, USA
*Correspondence address. JMI Laboratories, 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317, USA. Tel: +1-319-665-3370; Fax: +1-319-655-3371; E-mail: ronald-jones{at}jmilabs.com
Keywords: oxazolidinones , CoNS, resistant
Sir,
The letter from Kelly et al.1 illustrates the value of hospital-based surveillance for new antimicrobial agents. The detection of three confirmed linezolid-resistant (MIC > 4 mg/L) coagulase-negative staphylococci (Staphylococcus epidermidis from blood cultures) is significant and affirms the possibility of this event from earlier surveillance reports.2 Although oxazolidinone resistances among Staphylococcus aureus and enterococci have been more numerous in case reports and international surveillance programmes,3,4 other Gram-positive cocci such as viridans group streptococci3 and Streptococcus pneumoniae have also been identified with target site mutations.5
The vast majority of the emerging oxazolidinone-resistant isolates have been encountered in the USA,3,4 but some documented cases have occurred in Europe3 and South America.6 The dominant number of resistance occurrences have followed long-term linezolid exposure (often at suboptimal doses) that may extend weeks to years as described for the linezolid-resistant S. aureus found in a cystic fibrosis patient from Brazil.6 However, some resistant isolates have been isolated from patients not receiving linezolid with patient-to-patient spread suspected or proven.3
Very recently, investigators in the USA reported7 a large number of patients (25 cases) with linezolid-resistant S. epidermidis clonal infections attributed to long-term (>21 days; P < 0.001) oxazolidinone treatment and person-to-person transmission in an institution with a prior history of high-level resistances and epidemic spread in other species and agents. Clearly local emergence of linezolid resistance in coagulase-negative staphylococci has become an important concern1,7 that may not be detected by high organism volume surveillance programmes.8 Prospective local resistance surveillance should be encouraged in hospitals where extended courses of oxazolidinone therapy are applied to patients with compromising medical conditions, supported by an active infection control programme to limit the possibilities of the dissemination of resistant strains. Because of the paucity of newer effective antimicrobial agents, prudent use of linezolid remains a priority to preserve its clinical utility at levels that we currently enjoy (resistance rates at <1%).2,3,8
Transparency declarations
R. N. J., T. R. F. and H. S. S. are the recipients of educational/research grants from Pfizer, Inc.
References
1 Kelly S, Collins J, Davin M, et al. (2006) Linezolid resistance in coagulase-negative staphylococci. J Antimicrob Chemother 58: doi:10.1093/jac/dkl271.
2
Mutnick AH, Enne V, Jones RN. (2003) Linezolid resistance since 2001: SENTRY Antimicrobial Surveillance Program. Ann Pharmacother 37:769–74.
3 Anderegg TR, Sader HS, Fritsche TR, et al. (2005) Trends in linezolid susceptibility patterns: report from the 2002–2003 worldwide Zyvox Annual Appraisal of Potency and Spectrum (ZAAPS) Program. Int J Antimicrob Agents 26:13–21.[CrossRef][Web of Science][Medline]
4 Tsiodras S, Gold HS, Sakoulas G, et al. (2001) Linezolid resistance in a clinical isolate of Staphylococcus aureus. Lancet 358:207–8.[CrossRef][Web of Science][Medline]
5
Wolter N, Smith AM, Farrell DJ, et al. (2005) Novel mechanism of resistance to oxazolidinones, macrolides, and chloramphenicol in ribosomal protein L4 of the pneumococcus. Antimicrob Agents Chemother 49:3554–7.
6 Gales AC, Sader HS, Andrade SS, et al. (2006) Emergence of linezolid-resistant Staphylococcus aureus during treatment of pulmonary infection in a patient with cystic fibrosis. Int J Antimicrob Agents 27:300–2.[CrossRef][Web of Science][Medline]
7 Potoski BA, Adams J, Clarke L. (2006) Epidemiological profile of linezolid-resistant coagulase-negative staphylococci. Clin Infect Dis 43:165–71.[CrossRef][Web of Science][Medline]
8
Jones RN, Ross JE, Fritsche TR, et al. (2006) Oxazolidinone susceptibility patterns in 2004: report from the Zyvox® Annual Appraisal of Potency and Spectrum (ZAAPS) Program assessing isolates from 16 nations. J Antimicrob Chemother 57:279–87.
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