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JAC Advance Access published online on September 5, 2005
Journal of Antimicrobial Chemotherapy, 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
Received May 6, 2005
Revised August 3, 2005
Accepted August 12, 2005

Brief report

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

Stefanie Swoboda 1*, Stefan Fritz 2, Marcus E. Martignoni 2, Rita A. Feldhues 3, Torsten Hoppe-Tichy 1, Markus W. Buchler 2, and Heinrich K. Geiss 3

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

* To whom correspondence should be addressed.
Stefanie Swoboda, E-mail: stefanie.swoboda{at}med.uni-heidelberg.de


  Abstract

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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