Bacteriostatic or bactericidal effect of linezolid against multiresistant Streptococcus pneumoniae

The nasopharynx plays a critical role as the reservoir of Streptococcus pneumoniae, including drug-resistant strains particularly in children attending day care centers. A total 58 nasopharyngeal, multiresistant isolates of S. pneumoniae collected from healthy pre-school children were susceptible to linezolid (MIC = 0.25-1 mg/l), irrespective of serotype and drug resistance pattern. The majority of them (about 94%) were sensitive to the bactericidal effect of linezolid with MBCs = 0.5-4 mg/l. One isolate was killed at 8 mg/l of linezolid, while two at higher concentrations of this antibiotic with MBCs 16 or 32 mg/l, suggesting tolerance of linezolid. BOX-PCR fingerprinting data imply that two linezolid-tolerant strains belonged to distinct clones. Linezolid tolerance was confirmed by monitoring the viability of these isolates during exposure to 4 or 20 mg/l of this antibiotic. The linezolid-tolerant strains were sensitive to the bactericidal effect of vancomycin. Linezolid tolerance in clinical isolates of pneumococci may represent a potential therapeutic risk, especially in infections in which bactericidal activity of drug is critical for eradication of bacteria.