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Sequential linezolid-resistant Staphylococcus epidermidis isolates with G2576T mutation.

Tao Hong¹, Xiangyang Li, Jie Wang

¹Department of Pathology, Clinical Microbiology Laboratory, Hackensack University Medical Center, 30 Prospect Ave, Hackensack, NJ 07601, USA. thong@humed.com

Journal of Clinical Microbiology

|August 3, 2007

Summary

This study details linezolid-resistant Staphylococcus epidermidis bacteremia in an immunocompromised patient with acute myeloid leukemia. A G2576T mutation in the 23S rRNA gene was identified as the cause of treatment failure.

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Area of Science:

Microbiology
Genetics
Clinical Medicine

Background:

Linezolid is a crucial antibiotic for treating Gram-positive bacterial infections, including those caused by Staphylococcus epidermidis.
Acute myeloid leukemia (AML) patients are immunocompromised and susceptible to serious infections like bacteremia.
Monitoring antibiotic resistance is vital for effective patient management.

Observation:

Sequential blood isolates of Staphylococcus epidermidis were analyzed from an immunocompromised patient undergoing linezolid treatment for AML.
All 12 isolates exhibited a high minimum inhibitory concentration (MIC) of 32 microg/ml for linezolid.
Genetic analysis revealed a G2576T mutation in the domain V region of the 23S rRNA gene in all isolates.

Findings:

The G2576T mutation in the 23S rRNA gene was present in all Staphylococcus epidermidis isolates.
It is estimated that this mutation was present in 67% of the 23S rRNA genes within these isolates.
This represents the first documented instance of linezolid treatment failure for Staphylococcus epidermidis bacteremia linked to the G2576T mutation in an immunocompromised patient.

Implications:

The G2576T mutation confers significant linezolid resistance in Staphylococcus epidermidis.
This finding highlights the potential for rapid development of antibiotic resistance in immunocompromised patients.
Clinical guidelines may need to incorporate genetic resistance testing for linezolid in challenging cases.