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Enterococcus faecalis resistant to linezolid: case series and review of the literature

Brian S Burleson1, David J Ritchie, Scott T Micek

  • 1Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas, USA.

Pharmacotherapy
|October 6, 2004
PubMed

Insights

Reports of linezolid resistance in Enterococcus faecalis are rare but linked to extended linezolid therapy. This study identified three cases, highlighting the need to verify linezolid sensitivity in patients with recent or prolonged treatment.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Linezolid is a crucial antibiotic for treating infections caused by Gram-positive bacteria, including resistant strains.
  • Reports of linezolid resistance in Enterococcus faecalis have been infrequent, making emerging resistance a significant concern.

Observation:

  • Three patients developed linezolid-resistant Enterococcus faecalis after prolonged (>30 days) linezolid treatment.
  • All resistant strains harbored the G2576U mutation in the 23S rRNA gene.
  • A literature review identified additional cases in the US and Europe, all associated with extended linezolid therapy.

Findings:

  • Extended or recent linezolid therapy appears to be a risk factor for the development of linezolid-resistant Enterococcus faecalis.
  • The G2576U mutation in 23S rRNA is associated with linezolid resistance in these strains.

Implications:

  • Clinicians should verify linezolid sensitivity in patients with new systemic enterococcal isolates who have recently undergone linezolid therapy.
  • Monitoring for linezolid resistance is crucial in patients experiencing breakthrough enterococcal infections during linezolid treatment.
  • This underscores the importance of judicious antibiotic use and resistance surveillance.

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