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Saini V, Goyal N, Singh NP, Goswami M. Evaluation of errors during susceptibility reporting of glycopeptide antibiotics for enterococcal isolates on sole basis of widely used disk diffusion test. HEALTHCARE IN LOW-RESOURCE SETTINGS 2022. [DOI: 10.4081/hls.2022.10806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In resource limited settings, very often susceptibility reports glycopeptide antibiotics are released only on the basis of disk diffusion test. Determination of MIC by either E-strips or microbroth dilution tests can be of paramount importance in checking the errors that may have incurred with the singular use of disk diffusion tests. Distribution of errors in Vancomycin and Teicoplanin susceptibility reporting by disk diffusion test was evaluated in comparison with MIC determination with reference method of E-strip. A total of 40 isolates of Enterococcus species were obtained during the study period. In vancomycin susceptibility reporting, very major errors, major errors and minor errors were observed in 33.3%, 5.4% and 5% instances respectively. For teicoplanin, major errors were observed in 5.3% of instances. E test can be used in conjunction with disk diffusion where resources are limited. We have observed that by using a combination of both disk diffusion and MIC determination by E-strip methods for glycopeptide antibiotics, a majority of reporting errors can be addressed.
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Investigation of a vanA linezolid- and vancomycin-resistant Enterococcus faecium outbreak in the Southwest Indian Ocean (Reunion Island). Int J Antimicrob Agents 2022; 60:106686. [PMID: 36503708 DOI: 10.1016/j.ijantimicag.2022.106686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/09/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Dual resistance to linezolid and glycopeptides is a milestone reached by certain extensively drug-resistant (XDR) enterococci. This paper describes the molecular and epidemiological investigations of a linezolid-resistant and vancomycin-resistant Enterococcus faecium (E. faecium) (LVREf) outbreak in the French overseas territory of Reunion Island (Indian Ocean). METHODS All vancomycin-resistant Enterococcus (VRE) isolates detected on Reunion Island between 2015 and 2019 were included in the study. The VRE isolates were phenotypically characterised and genetically explored by whole-genome sequencing (WGS). RESULTS Sixteen vancomycin-resistant E. faecium (VREf) isolates were retrieved between 2015 and 2019. Seven isolates obtained in 2019 were involved in the outbreak. These seven LVREf isolates from the 2019 outbreak at the University Hospital of Reunion Island (UHRI) were suspected to be related to a linezolid-susceptible VREf strain imported from India. An epidemiological link was highlighted for six of the seven outbreak cases. All the LVREf outbreak isolates were obtained from rectal swabs (colonisation) and resistant to vancomycin (MIC > 128 mg/L) and linezolid (MIC 8-32 mg/L); one isolate was also resistant to daptomycin (MIC 8 mg/L). The seven outbreak isolates were positive for the vanA and optrA genes and belonged to ST761. CONCLUSIONS These results argue for the strict application of control and prevention measures for VRE clones at high risk of spread, particularly in areas such as Reunion Island where the risk of importation from the Indian subcontinent is high. The regional spread of optrA linezolid-resistance genes in VRE isolates is a matter of concern, due to possibility of treatment failure.
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Tayal A, Singh NP, Rai S, Gupta K, Gupta A, Agarwal AN, Saha R, Kaur IR. First study on detection of cryptic resistance to linezolid among clinical isolates of methicillin resistant Staphylococcus aureus from India. Indian J Med Microbiol 2022; 40:384-388. [PMID: 35667921 DOI: 10.1016/j.ijmmb.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/20/2022] [Accepted: 05/13/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Linezolid is an oral antibiotic which is widely used for serious infections caused by Methicillin Resistant Staphylococcus aureus (MRSA). With emergence of vancomycin MIC creep among clinical strains of MRSA, it is essential to know the possible emergence of subclinical resistance against linezolid as well. With this background, we aimed to detect evident (phenotypic) and cryptic (hidden or genotypic) linezolid resistance among MRSA isolates. METHODS 250 clinical isolates of MRSA were collected and their susceptibility patterns were determined. Every third MRSA isolate was subjected to PCR for domain V of the 23S rRNA for the mutation hotspot in the 746bp segment which harbors the classical mutation for linezolid resistance. Restriction Fragment Length Polymorphism was done to confirm presence of the G2576U mutation. RESULTS Six isolates (2.4%) were phenotypically resistant to linezolid. Among these six LRSA isolates, 5 demonstrated the G2576U mutation by PCR - RFLP. Cryptic resistance to Linezolid was identified in two isolates among linezolid susceptible isolates. CONCLUSIONS In the present study, hidden resistance to linezolid was observed in linezolid susceptible clinical isolates. Emergence of resistance against over-the-counter drugs like linezolid is major challenge. Identification of cryptic resistance among patients implies impending resistance to linezolid. Judicious use of antimicrobials, application of strict infection control practices and prescription audit needs to be made mandatory to preserve such drugs.
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Affiliation(s)
- Ayushi Tayal
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Narendra Pal Singh
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Sumit Rai
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Kavita Gupta
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Arun Gupta
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Aditya Nath Agarwal
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Rituparna Saha
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Iqbal Rajinder Kaur
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
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Bakthavatchalam YD, Vasudevan K, Babu P, Neeravi AR, Narasiman V, Veeraraghavan B. Genomic insights of optrA-carrying linezolid-resistant Enterococcus faecium using hybrid assembly: first report from India. J Glob Antimicrob Resist 2021; 25:331-336. [PMID: 33957286 DOI: 10.1016/j.jgar.2021.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/25/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Linezolid resistance in Enterococcus faecium is emerging worldwide. In this study, we aimed to characterise two linezolid-resistant E. faecium isolates using whole-genome sequencing. METHODS Antimicrobial susceptibility testing was performed by the broth microdilution method. A hybrid assembly approach of IonTorrent and MinION sequencing reads was used to generate the complete genome of linezolid-resistant E. faecium isolates VB3025 and VB3240. RESULTS VB3025 and VB3240 had minimum inhibitory concentration (MICs) for linezolid of 1024 μg/mL and 512 μg/mL, respectively. In addition, VB3025 was found to be resistant to both vancomycin and teicoplanin, while VB3240 was susceptible to these antibiotics. A hybrid assembly approach was used to generate the complete genome of VB3025 and VB3240 isolates harbouring the optrA gene. Notably, VB3025 carried two copies of optrA (chromosomal and plasmid), while in VB3240 optrA was identified on the chromosome. Interestingly, the plasmid pVB3025_2 co-carried the resistance gene clusters aph(3)-IIIa-sat4-ant(6)-Ia-ermB, the vanHAX operon and a copy of the optrA gene. Moreover, the optrA gene inserted into a Tn554 transposon carrying the ermA gene was identified in both VB3025 and VB3240 isolates. Furthermore, mutation analysis revealed the presence of a G2592T mutation in the 23S rRNA of both isolates. CONCLUSION This is the first study reporting optrA-positive linezolid-resistant E. faecium from India. A novel plasmid co-carrying vancomycin and linezolid resistance determinants highlights the threat for potential dissemination.
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Affiliation(s)
| | - Karthick Vasudevan
- Department of Clinical Microbiology, Christian Medical College, Vellore 632 004, Tamil Nadu, India
| | - Priyanka Babu
- Department of Clinical Microbiology, Christian Medical College, Vellore 632 004, Tamil Nadu, India
| | - Ayyan Raj Neeravi
- Department of Clinical Microbiology, Christian Medical College, Vellore 632 004, Tamil Nadu, India
| | - Vignesh Narasiman
- Department of Clinical Microbiology, Christian Medical College, Vellore 632 004, Tamil Nadu, India
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore 632 004, Tamil Nadu, India.
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Husain A, Rawat V, Umesh, Kumar M, Verma PK. Vancomycin, linezolid and daptomycin susceptibility pattern among clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) from Sub- Himalyan Center. J Lab Physicians 2020; 10:145-148. [PMID: 29692578 PMCID: PMC5896179 DOI: 10.4103/jlp.jlp_92_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION: The efficacy of vancomycin, drug of choice for methicillin-resistant Staphylococcus aureus (MRSA), has become questionable due to the emergence of MRSA isolates with reduced susceptibility. The present study was conducted to determine the vancomycin, linezolid, and daptomycin susceptibility pattern in clinical isolates of MRSA and to observe minimum inhibitory concentration (MIC) creep over 2 years if any. MATERIALS AND METHODS: MIC of vancomycin, linezolid, and daptomycin were determined by E-test in 198 MRSA isolates and their MIC 50, MIC 90, and geometric mean MIC were calculated. RESULTS: While all isolates were sensitive to vancomycin, linezolid, and daptomycin, MIC 90 of vancomycin increased from 1.5 μg/ml in 2015 to 2 μg/ml in 2016. The percentage of isolates with vancomycin MIC >2 μg/ml doubled in 2016 (12.9%) as compared to 2015 (6.1%). MIC 90 for linezolid remained steady as 3 μg/ml, but geometric mean MIC increased from 2.20 μg/ml in 2015 to 2.29 μg/ml in 2016, and more than 40% isolates showed MIC 3 μg/ml. MIC 90 and geometric mean MIC of daptomycin decreased from 0.75 μg/ml to 0.5 μg/ml and 0.50 μg/ml to 0.36 μg/ml in 2015 and 2016, respectively. CONCLUSION: MIC creep was observed with vancomycin. Although linezolid MIC was within the susceptible zone, more than 40% strains showing MIC 3 μg/ml may herald the future development of either resistant or heteroresistant. Daptomycin showed good sensitivity against MRSA isolates. Therefore, it could be considered as an alternative agent for the treatment of infections caused by MRSA. However, it should be reserved where this class has a clear therapeutic advantage over other anti-MRSA drugs.
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Affiliation(s)
- Afzal Husain
- Department of Microbiology, Government Medical College, Haldwani, Uttarakhand, India
| | - Vinita Rawat
- Department of Microbiology, Government Medical College, Haldwani, Uttarakhand, India
| | - Umesh
- Department of Microbiology, Government Medical College, Haldwani, Uttarakhand, India
| | - Mukesh Kumar
- Department of Microbiology, Government Medical College, Haldwani, Uttarakhand, India
| | - Pankaj Kumar Verma
- Department of Surgery, Government Medical College, Haldwani, Uttarakhand, India
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Vijayan P, Srinivas D, Siddaiah N, Bahubali VKH. Device-Associated Meningitis by Linezolid-Resistant Staphylococcus haemolyticus in a Vancomycin- Hypersensitive Patient. J Neurosci Rural Pract 2019; 10:718-720. [PMID: 31831996 PMCID: PMC6906101 DOI: 10.1055/s-0039-3399599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Postsurgical device-related meningitis caused by multidrug-resistant coagulase-negative staphylococci often complicates the treatment options. We report a rare and, to our knowledge, the first clinical case report of drain-associated meningitis caused by methicillin- and linezolid-resistant Staphylococcus haemolyticus following linezolid therapy in a vancomycin-hypersensitive patient subsequently treated with cotrimoxazole, resulting in clinical improvement. The molecular mechanisms responsible for linezolid resistance were found to be the presence of G2576T mutation in domain V of 23srRNA region, which often arises during linezolid usage and also carriage of cfr gene, which promotes resistance independent of antibiotic pressure. We emphasize on monitoring the rational use of linezolid to avoid the spread of resistance and also comprehensive perioperative care to prevent health care-associated infection.
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Affiliation(s)
- Priya Vijayan
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Nagarathna Siddaiah
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Veeraraghavan B, Walia K. Antimicrobial susceptibility profile & resistance mechanisms of Global Antimicrobial Resistance Surveillance System (GLASS) priority pathogens from India. Indian J Med Res 2019; 149:87-96. [PMID: 31219073 PMCID: PMC6563747 DOI: 10.4103/ijmr.ijmr_214_18] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Antimicrobial resistance is a major concern globally. Infections due to drug-resistant pathogens are becoming difficult and a challenge to treat. As treatment choices are limited due to the high-drug resistance rates, there is an increase in the health care cost, duration of hospital stay, morbidity and mortality rates. Understanding the true burden of antimicrobial resistance for a geographical location is important to guide effective empirical therapy. To have a national data, it is imperative to have a systemic data capturing across the country through surveillance studies. Very few surveillance studies have been conducted in India to generate national data on antimicrobial resistance. This review aims to report the cumulative antibiogram and the resistance mechanisms of Global Antimicrobial Resistance Surveillance System (GLASS) priority pathogens from India.
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Affiliation(s)
| | - Kamini Walia
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Purohit G, Gaind R, Dawar R, Verma PK, Aggarwal KC, Sardana R, Deb M. Characterization of Vancomycin Resistant Enterococci in Hospitalized Patients and Role of Gut Colonization. J Clin Diagn Res 2017; 11:DC01-DC05. [PMID: 29207701 DOI: 10.7860/jcdr/2017/25988.10548] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 06/06/2017] [Indexed: 11/24/2022]
Abstract
Introduction Enterococci are part of the normal intestinal flora and have been recognized as important human pathogens. Vancomycin Resistant Enterococci (VRE) are global threat as this resistance is transmissible and also poses a challenge for infection control. Aim This study was undertaken to study phenotypic and genotypic characteristics of VRE from clinically significant infections among hospitalized patients and their association with gut colonization. Materials and Methods Clinically significant isolates of enterococci (n=250) were studied. Species confirmation was done by Polymerase Chain Reaction (PCR). Minimum Inhibitory Concentration (MIC) for vancomycin was determined by E-test. PCR for VanA, VanB and VanC1 gene was done for genotypic characterization. MIC for teicoplanin, linezolid, tigecycline, daptomycin and quinupristin-dalfopristin was determined by E test. Patients with VRE infection were screened for gut colonization using vancomycin screen agar (6 μg/mL). Continuous data was analysed using the Student's t-test. Categorical data was assessed using Pearson's Chi-square test. A value of p ≤ 0.05 was considered statistically significant. Results There was good correlation between the phenotypic and genotypic methods used for species identification and detection of vancomycin resistance. E. faecium (162, 64.8%) was most common followed by E. faecalis (82, 32.84%) and E. gallinarum (6, 2.4%). Overall higher resistance was observed among E. faecium. Vancomycin MIC ≥ 2 μg/mL was noted in 63 (25.2%) isolates. Fifty seven isolates showed presence of vanA and vanC1 was detected in six isolates of E. gallinarum. Isolates with VanB genotype was not detected in the present study. MIC50 (μg/mL) for teicoplanin, linezolid, tigecycline, daptomycin and quinupristin-dalfopristrin was 24, 0.75, 0.064, 2 and 0.064 respectively. Resistance to linezolid (1, 1.6%) and tigecycline (2, 3.2%) was rare. Majority (33/47, 70.2%) patients with clinically significant VRE infection showed gut colonization. Conclusion Vancomycin resistance among enterococci is emerging. Emergence of tigecycline and linezolid resistance is also posing a challenge for clinicians. Thus, further investigations are warranted to control vancomycin resistance among pathogens.
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Affiliation(s)
- Geetarani Purohit
- Senior Resident, Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Rajni Gaind
- Professor and Head, Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Reetika Dawar
- Senior Consultant, Department of Microbiology, Apollo Hospital, New Delhi, India
| | - P K Verma
- Professor, Department of Anaesthesia, VMMC and Safdarjung Hospital, New Delhi, India
| | - K C Aggarwal
- Professor and Head, Department of Paediatrics, VMMC and Safdarjung Hospital, New Delhi, India
| | - Raman Sardana
- Senior Consultant, Department of Microbiology, Apollo Hospital, New Delhi, India
| | - Monorama Deb
- Director Professor, Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, India
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Gandra S, Mojica N, Klein EY, Ashok A, Nerurkar V, Kumari M, Ramesh U, Dey S, Vadwai V, Das BR, Laxminarayan R. Trends in antibiotic resistance among major bacterial pathogens isolated from blood cultures tested at a large private laboratory network in India, 2008-2014. Int J Infect Dis 2016; 50:75-82. [PMID: 27522002 PMCID: PMC5063511 DOI: 10.1016/j.ijid.2016.08.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE There have been no long-term studies on trends in antibiotic resistance (ABR) on a national scale in India. Using a private laboratory network, the ABR patterns of organisms most commonly associated with bacteremia, obtained from patients across India between 2008 and 2014, were examined. METHODS A retrospective study of patient blood cultures collected over a 7-year period (January 1, 2008-December 31, 2014) was conducted. Data on the microorganism(s) identified and their antimicrobial susceptibility were obtained from SRL Diagnostics (Mumbai, India). RESULTS Of 135268 blood cultures, 18695 (14%) had at least one identified pathogen. In addition to continual high rates of methicillin-resistant Staphylococcus aureus (MRSA; approximately 44.2%), high resistance to nalidixic acid among Salmonella Typhi (98%) was observed, and carbapenem resistance increased in both Escherichia coli (7.8% to 11.5%; p=0.332) and Klebsiella pneumoniae (41.5% to 56.6%; p<0.001). Carbapenem resistance was also stable and high for both Acinetobacter species (approximately 69.6%) and Pseudomonas aeruginosa (approximately 49%). Resistance was also detected to colistin in the Gram-negatives and to vancomycin and linezolid in S. aureus. CONCLUSION Increasing resistance to antibiotics of last-resort, particularly among Gram-negatives, suggests an urgent need for new antibiotics and improved antimicrobial stewardship programs in India.
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Affiliation(s)
- Sumanth Gandra
- Center for Disease Dynamics, Economics and Policy, New Delhi, India
| | - Nestor Mojica
- Center for Disease Dynamics, Economics and Policy, New Delhi, India
| | - Eili Y Klein
- Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland, USA; Center for Disease Dynamics, Economics and Policy, 1400 Eye Street NW, Suite 500, Washington, DC, 20005, USA
| | - Ashvin Ashok
- Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland, USA
| | | | | | | | | | | | | | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics and Policy, New Delhi, India; Public Health Foundation of India, Gurgaon, India; Princeton Environmental Institute, Princeton, New Jersey, USA.
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Rai S, Rani M, Choudhury DD, Singh NP, Gupta A, Manchanda V. Failure to decolonize mupirocin and linezolid resistant MRSA from a patient with necrotizing soft tissue infection. J Infect Public Health 2016; 9:667-9. [PMID: 26837722 DOI: 10.1016/j.jiph.2015.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/24/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022] Open
Abstract
Colonization with methicillin resistant Staphylococcus aureus (MRSA) is considered to be a major risk factor for skin and soft tissue infections. We present a case of a patient suffering from necrotizing soft tissue infection and exposed to multiple antibiotics and developed colonization with linezolid resistant MRSA (LRMRSA). He could not be decolonized despite prolonged conventional or modified MRSA decolonization protocols.
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Affiliation(s)
- Sumit Rai
- Department of Clinical Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
| | - Mayuri Rani
- Department of Clinical Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Debapriya D Choudhury
- Department of Clinical Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Narendra P Singh
- Department of Clinical Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Arun Gupta
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Vikas Manchanda
- Department of Clinical Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
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