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JAC Advance Access published online on May 30, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl233
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© The Author 2006. 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 March 17, 2006
Revised May 5, 2006
Accepted May 11, 2006

Brief report

In vitro susceptibility of Gram-positive pathogens to linezolid and teicoplanin and effect on outcome in critically ill patients

A. Peter R. Wilson 1 *, Jorge A. Cepeda 1, Samantha Hayman 1, Tony Whitehouse 2, Mervyn Singer 2, and Geoffrey Bellingan 2

1 Department of Clinical Microbiology, University College London Hospitals, 46 Cleveland Street, London W1T 4JF, UK
2 Bloomsbury Institute of Intensive Care Medicine, Department of Medicine, UCL Gower Street, London WC1E 6BT, UK

* To whom correspondence should be addressed.
A. Peter R. Wilson, E-mail: peter.wilson{at}uclh.nhs.uk


  Abstract

Objectives: To determine the prevalence of teicoplanin and linezolid resistance amongst Gram-positive pathogens isolated in the intensive care unit (ICU) and the impact of any resistance on clinical outcome.

Methods: Gram-positive isolates were collected from two critical care units over 1 year. All patients were screened weekly for methicillin-resistant Staphylococcus aureus (MRSA). Susceptibility to teicoplanin and linezolid was tested by Etest. The length of hospital and critical care unit stay and the use of antibiotics in each patient were recorded.

Results: Reduced susceptibility to teicoplanin (MIC ≥ 16 mg/L) was found in 21 [3.3% (95% CI 2.0-5.0%) 6 patients] of 643 strains of MRSA versus none of 374 methicillin-susceptible S. aureus (MSSA) [<0.3% (95% CI 0-0.9%)]. Of 49 enterococci 3 were teicoplanin-resistant. All Gram-positive isolates were susceptible to linezolid. The length of treatment with teicoplanin and outcome of patients infected with these strains were similar to that of susceptible strains. MRSA was a more common cause of infection than MSSA but a less frequent colonizer.

Conclusions: Resistance to teicoplanin remains at a comparatively low level and there was no clear relationship between susceptibility and outcome in this critically ill population. There was no resistance in Gram-positives to linezolid but this should be kept as a reserve antibiotic to maintain its activity.

Keywords: critical care; MRSA; glycopeptides.
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