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The Emergence of Linezolid-Resistant Staphylococcus Epidermidis in the COVID-19 Hospitalized Intubated Patients in
Roya Sadidi1, Hatef Ajoudanifar1, Hamed Ghasem Zadeh-Moghadam2
1Department of Biology, College of Basic Sciences, Damghan Branch, Islamic Azad University, Damgan, Iran.
Abstract:
The present study aimed to investigate secondary bacterial infections among patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Coagulase-negative Staphylococci can infect immunocompromised patients. Linezolid resistance among Staphylococcus epidermidis is one of the most critical issues. In 2019, 185 SARS-CoV-2-positive patients who were admitted to North Khorasan Province Hospital (Bojnurd, Iran), were investigated. Patients having positive SARS-CoV-2 reverse transcriptase real-time polymerase chain reaction (RT-PCR) test results, who had a history of intubation, mechanical ventilation, and were hospitalized for more than 48 hours were included. After microbiological evaluation of pulmonary samples, taken from intubated patients with clinical manifestation of pneumonia, co-infections were found in 11/185 patients (5.94%) with S. epidermidis, Staphylococcus aureus, and Acinetobacter baumani, respectively. Remarkably, seven out of nine S. epidermidis isolates were linezolid resistant. Selected isolates were characterized using antimicrobial resistance patterns and molecular methods, such as Staphylococcal cassette chromosome mec (SCCmec) typing, and gene detection for ica, methicillin resistance (mecA), vancomycin resistance (vanA), and chloramphenicol-florfenicol resistance (cfr) genes. All of the isolates were resistant to methicillin, and seven isolates were resistant to linezolid. Nine out of 11 isolated belonged to the SCCmec I, while two belonged to the SCCmec IV. It should be noted that all patients had the underlying disease, and six patients had already passed away. The increasing linezolid resistance in bacterial strains becomes a real threat to patients, and monitoring such infections, in conjunction with surveillance and infection prevention programs, is very critical for reducing the number of linezolid-resistant Staphylococcal strains. A preprint of this study was published at https://europepmc.org/article/ppr/ppr417742.
Insights
Secondary bacterial infections, including linezolid-resistant Staphylococcus epidermidis, were found in SARS-CoV-2 patients. This highlights the critical need for surveillance and infection control to combat rising antimicrobial resistance threats.
Area of Science:
- Infectious Diseases
- Microbiology
- Critical Care Medicine
Background:
- Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can predispose patients to secondary bacterial infections, particularly in immunocompromised individuals.
- Coagulase-negative Staphylococci, such as Staphylococcus epidermidis, pose a significant threat, with increasing linezolid resistance being a critical concern.
Purpose of the Study:
- To investigate the prevalence and characteristics of secondary bacterial infections in SARS-CoV-2 patients.
- To identify specific bacterial pathogens and assess their antimicrobial resistance patterns, focusing on linezolid resistance in Staphylococcus epidermidis.
Main Methods:
- Retrospective analysis of 185 SARS-CoV-2 positive patients hospitalized between January and March 2019.
- Microbiological evaluation of pulmonary samples from intubated patients with pneumonia.
- Antimicrobial resistance profiling and molecular characterization including SCCmec typing and detection of resistance genes (mecA, vanA, cfr).
Main Results:
- Co-infections were identified in 5.94% (11/185) of patients, with Staphylococcus epidermidis, Staphylococcus aureus, and Acinetobacter baumannii being the most common.
- Seven out of nine Staphylococcus epidermidis isolates exhibited resistance to linezolid, and all isolates were methicillin-resistant.
- Nine isolates belonged to SCCmec type I, and two to SCCmec type IV. Six patients with underlying diseases did not survive.
Conclusions:
- Secondary bacterial infections, particularly those involving linezolid-resistant Staphylococcus epidermidis, are a significant complication in severe SARS-CoV-2 cases.
- The high prevalence of linezolid resistance underscores the urgent need for enhanced surveillance and infection prevention strategies to mitigate the threat of multidrug-resistant organisms.
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