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Increasing Linezolid-resistant Enterococcus in a Children's Hospital.

Bindiya Bagga, Steve Buckingham, Sandra Arnold

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    Susceptibility to linezolid in Enterococcus isolates significantly decreased between 2007 and 2014. While linezolid use increased, direct patient exposure wasn't the sole cause, suggesting nosocomial transmission may play a role.

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    Area of Science:

    • Antimicrobial resistance
    • Infectious diseases
    • Clinical microbiology

    Background:

    • Linezolid is a critical antibiotic for treating infections caused by multidrug-resistant Gram-positive bacteria.
    • Emergence of linezolid resistance is a growing concern in clinical settings.
    • Enterococcus species are common causes of nosocomial infections and can develop resistance to antibiotics.

    Purpose of the Study:

    • To investigate trends in linezolid susceptibility among Enterococcus isolates over a defined period.
    • To explore potential associations between linezolid usage patterns and the prevalence of nonsusceptible isolates.
    • To identify contributing factors, including patient exposure and potential transmission routes, for reduced linezolid susceptibility.

    Main Methods:

    • Retrospective analysis of Enterococcus isolates collected between 2007 and 2014.
    • Antimicrobial susceptibility testing to determine linezolid resistance.
    • Review of patient data to assess linezolid exposure history and identify potential nosocomial transmission.

    Main Results:

    • A significant reduction in linezolid susceptibility was observed in Enterococcus isolates, decreasing from 98% in 2007 to 46% in 2014.
    • A five-fold increase in linezolid utilization was recorded during the study period.
    • The majority of patients harboring linezolid-nonsusceptible isolates had no documented prior exposure to linezolid.

    Conclusions:

    • The rise in linezolid-nonsusceptible Enterococcus isolates is a significant clinical concern.
    • While increased linezolid use is noted, direct patient exposure does not fully explain the observed resistance trends.
    • Nosocomial transmission of linezolid-nonsusceptible Enterococcus strains is a likely contributing factor requiring further investigation and control measures.