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Lee JY, Howden BP. Vancomycin in the treatment of methicillin-resistant Staphylococcus aureus - a clinician's guide to the science informing current practice. Expert Rev Anti Infect Ther 2015; 13:855-69. [PMID: 25947636 DOI: 10.1586/14787210.2015.1041924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Clinicians treating an infection assess a patient in terms of disease manifestation, causative organism and available antibiotic options with the aim of devising a therapeutic strategy under the creed of 'first, do no harm'. It is often only when treatment is failing or options are limited, as in the scenario of multidrug-resistant organisms, that consideration is given to the interplay that occurs between the microbe and the host. The emergence of Staphylococcus aureus with reduced susceptibility to vancomycin provides a prime example of these dynamic interactions. This review shall explore these concepts in relation to vancomycin for the treatment of methicillin-resistant S. aureus, with the aim of providing an informed approach to the utilization of this drug.
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Affiliation(s)
- Jean Yh Lee
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Doherty Institute for Infection and Immunity, Parkville, 3010, Victoria, Australia
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152
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Klare I, Fleige C, Geringer U, Thürmer A, Bender J, Mutters NT, Mischnik A, Werner G. Increased frequency of linezolid resistance among clinical Enterococcus faecium isolates from German hospital patients. J Glob Antimicrob Resist 2015; 3:128-131. [PMID: 27873661 DOI: 10.1016/j.jgar.2015.02.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/19/2015] [Accepted: 02/21/2015] [Indexed: 11/17/2022] Open
Abstract
Linezolid is an antibiotic of last resort for the treatment of infections with vancomycin-resistant enterococci (VRE). Here we report the increasing prevalence of linezolid resistance among clinical Enterococcus faecium strains from German hospital patients. Linezolid minimum inhibitory concentrations (MICs) were determined for 4461 clinical E. faecium strains isolated between 2008 and 2014. Isolates originated from the network of diagnostic laboratories collaborating with the National Reference Centre (NRC) for Staphylococci and Enterococci covering all German federal states. All linezolid-resistant isolates were determined by broth microdilution and confirmed by Etest as well as by analysing the 23S rDNA for putative mutations. Marker genes were determined by PCR. Genotyping was performed by SmaI macrorestriction analysis in pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) for selected isolates. An increase in linezolid resistance was observed, from <1% in 2008 to >9% in 2014. Occasionally, outbreaks with linezolid-resistant VRE (ST117) were observed. In total, 232 (92.4%) of 251 linezolid-resistant E. faecium isolates (including 61 vanA and 29 vanB) contained the G2576T 23S rDNA mutation and showed a varying mixture of wild-type and mutated alleles per genome sufficient to confer linezolid resistance. In vitro growth experiments revealed a stable linezolid MIC. Of the 251 linezolid-resistant isolates, 5 were cfr-positive. In conclusion, these NRC data identified a country-wide ongoing trend of increasing linezolid resistance among clinical E. faecium isolates within the last 5 years.
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Affiliation(s)
- Ingo Klare
- National Reference Centre (NRC) for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Burgstraße 37, D-38855 Wernigerode, Germany
| | - Carola Fleige
- National Reference Centre (NRC) for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Burgstraße 37, D-38855 Wernigerode, Germany
| | - Uta Geringer
- National Reference Centre (NRC) for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Burgstraße 37, D-38855 Wernigerode, Germany
| | - Alexander Thürmer
- Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fiedlerstraße 42, D-01307 Dresden, Germany
| | - Jennifer Bender
- National Reference Centre (NRC) for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Burgstraße 37, D-38855 Wernigerode, Germany
| | - Nico T Mutters
- Heidelberg University Hospital, Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg, Germany
| | - Alexander Mischnik
- Division of Infectious Diseases, Department of Medicine, University Medical Center Freiburg, 79106 Freiburg, Germany
| | - Guido Werner
- National Reference Centre (NRC) for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Burgstraße 37, D-38855 Wernigerode, Germany.
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153
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Flamm RK, Mendes RE, Hogan PA, Ross JE, Farrell DJ, Jones RN. In vitro activity of linezolid as assessed through the 2013 LEADER surveillance program. Diagn Microbiol Infect Dis 2015; 81:283-9. [DOI: 10.1016/j.diagmicrobio.2014.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/22/2014] [Accepted: 12/24/2014] [Indexed: 11/29/2022]
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154
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Bender J, Strommenger B, Steglich M, Zimmermann O, Fenner I, Lensing C, Dagwadordsch U, Kekulé AS, Werner G, Layer F. Linezolid resistance in clinical isolates of Staphylococcus epidermidis from German hospitals and characterization of two cfr-carrying plasmids. J Antimicrob Chemother 2015; 70:1630-8. [PMID: 25740949 DOI: 10.1093/jac/dkv025] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/21/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study was a detailed investigation of Staphylococcus epidermidis clinical isolates exhibiting linezolid resistance. METHODS Thirty-six linezolid-resistant S. epidermidis from eight German hospitals, including isolates from suspected hospital-associated outbreaks between January 2012 and April 2013, were analysed with respect to their antimicrobial susceptibility and the presence of cfr and/or mutations in the 23S rRNA, rplC, rplD and rplV genes. Relatedness of isolates was estimated by MLST and SmaI macrorestriction analysis. Characterization of cfr plasmids was carried out by means of Illumina sequencing. RESULTS The MICs of linezolid varied substantially between the isolates. No apparent correlation was detected between the level of resistance, the presence of cfr and ribosomal target site mutations. S. epidermidis isolates from two hospitals were confirmed as clonally related, indicating the spread of the respective clone over a period of 1 year. Next-generation sequencing revealed two different categories of cfr-expressing plasmids, both of them varying in genetic arrangement and composition from previously published cfr plasmids: p12-00322-like plasmids showed incorporation of cfr into a pGO1-like backbone and displayed capabilities for intra- and inter-species conjugational transfer. CONCLUSIONS To date, linezolid-resistant S. epidermidis have rarely been isolated from human clinical sources in Germany. Here, we describe the emergence and outbreaks of these strains. We detected previously described and novel point mutations in the 23S ribosomal genes. The cfr gene was only present in six isolates. However, this is the first known description of cfr incorporation into conjugative vectors; under selective pressure, these vectors could give reasonable cause for concern.
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Affiliation(s)
- Jennifer Bender
- National Reference Centre for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Birgit Strommenger
- National Reference Centre for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Matthias Steglich
- National Reference Centre for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Ortrud Zimmermann
- Institute of Medical Microbiology, University Medical Centre Göttingen, Kreuzbergring 57, 37075 Göttingen, Germany
| | - Ines Fenner
- MVZ Labor Fenner und Kollegen, Bergstraße 14, 20095 Hamburg, Germany
| | - Carmen Lensing
- MVZ Labor Fenner und Kollegen, Bergstraße 14, 20095 Hamburg, Germany
| | - Urantschimeg Dagwadordsch
- Institute of Medical Microbiology, Martin Luther University Halle/Wittenberg, Magdeburger Straße 6, 06112 Halle, Germany
| | - Alexander S Kekulé
- Institute of Medical Microbiology, Martin Luther University Halle/Wittenberg, Magdeburger Straße 6, 06112 Halle, Germany
| | - Guido Werner
- National Reference Centre for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Franziska Layer
- National Reference Centre for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
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155
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Update on linezolid in vitro activity through the Zyvox Annual Appraisal of Potency and Spectrum Program, 2013. Antimicrob Agents Chemother 2015; 59:2454-7. [PMID: 25645839 DOI: 10.1128/aac.04784-14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Linezolid showed MIC50s and MIC90s of 1 μg/ml (for both) against Staphylococcus aureus. Two S. aureus strains exhibited higher MICs (4 to 8 μg/ml) caused by cfr and/or target site mutations, including the first detection of cfr in Poland. Linezolid (MIC50 and MIC90, 0.5 and 1 μg/ml) had potent MICs against coagulase-negative staphylococci (CoNS). Four CoNS had MICs of 16 to 128 μg/ml due to alterations in 23S rRNA and/or L3/L4. Linezolid inhibited all enterococci and streptococci at ≤2 μg/ml, except for one Enterococcus faecium strain (MIC, 8 μg/ml; G2576T [Escherichia coli numbering] mutation).
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156
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Rossolini GM, Arena F, Pecile P, Pollini S. Update on the antibiotic resistance crisis. Curr Opin Pharmacol 2014; 18:56-60. [DOI: 10.1016/j.coph.2014.09.006] [Citation(s) in RCA: 313] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/05/2014] [Indexed: 01/03/2023]
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