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A 1.5 Hour Procedure for Identification of Enterococcus Species Directly from Blood Cultures

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Published on: February 10, 2011

Infections due to vancomycin-resistant Enterococcus faecium resistant to linezolid.

R D Gonzales, P C Schreckenberger, M B Graham

Lancet (London, England)

|April 27, 2001

Summary

Emergence of linezolid resistance in vancomycin-resistant enterococci (VRE) infections is rare but can occur, especially in transplant patients with prolonged treatment. Susceptibility testing is recommended at the start of therapy.

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Area of Science:

Infectious Diseases
Microbiology
Pharmacology

Background:

Linezolid is a crucial antibiotic for treating infections caused by vancomycin-resistant enterococci (VRE).
Early clinical trials indicated a low incidence of resistance emergence during linezolid therapy.
VRE infections pose a significant challenge, particularly in immunocompromised patients.

Observation:

This report details five cases of VRE infections treated with linezolid where resistant organisms were isolated during therapy.
Four of these patients were transplant recipients undergoing extended linezolid treatment.
Three cases were associated with treatment failure, highlighting potential therapeutic limitations.

Findings:

One out of 45 patients treated with linezolid developed resistance during the course of therapy.
The emergence of resistance was more frequently observed in transplant patients receiving prolonged linezolid treatment.
Clinical outcomes included treatment failure in three of the reported cases.

Implications:

The findings suggest that while rare, linezolid resistance can emerge in VRE infections.
Protracted linezolid therapy, especially in immunocompromised hosts like transplant patients, may be associated with a higher risk of resistance.
Routine antibiotic susceptibility testing for linezolid should be considered at the initiation of therapy for VRE infections to guide treatment decisions and monitor for resistance.