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Bender JK, Baufeld E, Becker K, Claus H, Dudakova A, Dörre A, Fila N, Fleige C, Hamprecht A, Hoffmann A, Hogardt M, Kaasch AJ, Kola A, Kriebel N, Layer-Nicolaou F, Marschal M, Molitor E, Mutters NT, Liese J, Nelkenbrecher C, Neumann B, Rohde H, Steinmann J, Sörensen M, Thelen P, Weig M, Zautner AE, Werner G. CHROMAgar™ LIN-R as an efficient screening tool to assess the prevalence of linezolid-resistant enterococci in German hospital patients-a multicentre study approach, 2021-2022. J Antimicrob Chemother 2023; 78:2185-2191. [PMID: 37473450 PMCID: PMC10477123 DOI: 10.1093/jac/dkad218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND In recent years, an increasing number of linezolid-resistant enterococci (LRE) was recognized at the German National Reference Centre (NRC) for Enterococci. National guidelines on infection prevention recommend screening for LRE in epidemiologically linked hospital settings without referring to a reliable and rapid diagnostic method. Since 2020, CHROMAgar™ provide a chromogenic linezolid screening agar, LIN-R, suitable to simultaneously screen for linezolid-resistant staphylococci and enterococci. OBJECTIVES To assess the applicability of CHROMAgar™ LIN-R in clinical settings for detecting LRE directly from patient material and to infer prevalence rates of LRE amongst German hospital patients. METHODS During the 3-month trial period, clinical samples were plated on CHROMAgar™ LIN-R. Antimicrobial susceptibility testing was performed using VITEK2 or disc diffusion. At the NRC, linezolid resistance was determined by broth microdilution, multiplex-PCR for cfr/optrA/poxtA and by a restriction-based assay for 23S rDNA mutations. RESULTS The 12 participating study sites used 13 963 CHROMAgar™ LIN-R plates during the study period. Of 442 presumptive LRE, 192 were confirmed by phenotypic methods. Of these, 161 were received by the NRC and 121 (75%) were verified as LRE. Most of LR-E. faecium 53/81 (65%) exhibited a 23S rRNA gene mutation as the sole resistance-mediating mechanism, whereas optrA constituted the dominant resistance trait in LR-E. faecalis [39/40 (98%)]. Prevalence of LRE across sites was estimated as 1% (ranging 0.18%-3.7% between sites). CONCLUSIONS CHROMAgar™ LIN-R represents a simple and efficient LRE screening tool in hospital settings. A high proportion of false-positive results demands validation of linezolid resistance by a reference method.
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Affiliation(s)
- Jennifer K Bender
- Nosocomial Pathogens and Antibiotic Resistances Unit, Department of Infectious Diseases, National Reference Centre for Staphylococci and Enterococci, Robert Koch Institute, Wernigerode, Germany
| | - Elsa Baufeld
- Friedrich Loeffler Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Karsten Becker
- Friedrich Loeffler Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Heike Claus
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Anna Dudakova
- Institute for Medical Microbiology and Virology, University Medical Center Göttingen, Göttingen, Germany
| | - Achim Dörre
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Nikoletta Fila
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Carola Fleige
- Nosocomial Pathogens and Antibiotic Resistances Unit, Department of Infectious Diseases, National Reference Centre for Staphylococci and Enterococci, Robert Koch Institute, Wernigerode, Germany
| | - Axel Hamprecht
- Institute for Medical Microbiology and Virology, Carl von Ossietzky University Oldenburg and Klinikum Oldenburg, Oldenburg, Germany
| | - Armin Hoffmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hogardt
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Achim J Kaasch
- Faculty of Medicine, Institute of Medical Microbiology and Hospital Hygiene, Otto-von-Guericke-University, Magdeburg, Germany
- Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Axel Kola
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nancy Kriebel
- Nosocomial Pathogens and Antibiotic Resistances Unit, Department of Infectious Diseases, National Reference Centre for Staphylococci and Enterococci, Robert Koch Institute, Wernigerode, Germany
| | - Franziska Layer-Nicolaou
- Nosocomial Pathogens and Antibiotic Resistances Unit, Department of Infectious Diseases, National Reference Centre for Staphylococci and Enterococci, Robert Koch Institute, Wernigerode, Germany
| | - Matthias Marschal
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Ernst Molitor
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Nico T Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Jan Liese
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Claudia Nelkenbrecher
- Institute of Hospital Hygiene, Medical Microbiology and Infectious Diseases, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Bernd Neumann
- Institute of Hospital Hygiene, Medical Microbiology and Infectious Diseases, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Holger Rohde
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Steinmann
- Institute of Hospital Hygiene, Medical Microbiology and Infectious Diseases, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Michael Sörensen
- Laboratory Prof. Gisela Enders and Colleagues, Stuttgart, Germany
| | - Philipp Thelen
- Institute for Medical Microbiology and Virology, Carl von Ossietzky University Oldenburg and Klinikum Oldenburg, Oldenburg, Germany
| | - Michael Weig
- Institute for Medical Microbiology and Virology, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas E Zautner
- Faculty of Medicine, Institute of Medical Microbiology and Hospital Hygiene, Otto-von-Guericke-University, Magdeburg, Germany
- Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Guido Werner
- Nosocomial Pathogens and Antibiotic Resistances Unit, Department of Infectious Diseases, National Reference Centre for Staphylococci and Enterococci, Robert Koch Institute, Wernigerode, Germany
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Girlich D, Mihaila L, Cattoir V, Laurent F, Begasse C, David F, Metro CA, Dortet L. Evaluation of CHROMagar™ LIN-R for the Screening of Linezolid Resistant Staphylococci from Positive Blood Cultures and Nasal Swab Screening Samples. Antibiotics (Basel) 2022; 11:antibiotics11030313. [PMID: 35326776 PMCID: PMC8944678 DOI: 10.3390/antibiotics11030313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 11/18/2022] Open
Abstract
The increasing number of nosocomial pathogens with resistances towards last resort antibiotics, like linezolid for gram positive bacteria, leads to a pressing need for screening and, consequently, suitable screening media. Some national guidelines on infection prevention (e.g., in Germany) have already recommended screening for linezolid-resistant bacteria, despite an accurate screening medium that was not available yet. In this study, we analyzed the performance and reliability of the first commercial chromogenic medium, CHOMagar™ LIN-R, for screening of linezolid-resistant gram-positive isolates. Thirty-four pure bacterial cultures, 18 positive blood cultures, and 358 nasal swab screening samples were tested. This medium efficiently detected linezolid-resistant S. epidermidis isolates from pure bacterial cultures and from positive blood cultures with a high sensitivity (100%) and specificity (100%). Among the 358 nasal swab screening samples prospectively tested, 10.9% were cultured with linezolid-resistant isolates (mostly S. epidermidis). Of note, slight growth was observed for 7.5% samples with linezolid-susceptible isolates of S. epidermidis (n = 1), S. aureus (n = 1), Enterococcus faecalis (n = 4), Lactobacillus spp. (n = 3), gram negatives (n = 18). Moreover, few Candida spp. also cultured on this medium (1.4%).
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Affiliation(s)
- Delphine Girlich
- INSERM UMR1184-Team RESIST, Faculty of Medicine, Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France;
| | - Liliana Mihaila
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France; (L.M.); (C.B.); (F.D.); (C.-A.M.)
| | - Vincent Cattoir
- Department of Clinical Microbiology and National Reference Center for Enterococci, University Hospital of Rennes, 35033 Rennes, France;
| | - Frédéric Laurent
- National Reference Center for Staphylococci, Hospices Civils de Lyon, 69002 Lyon, France;
| | - Christine Begasse
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France; (L.M.); (C.B.); (F.D.); (C.-A.M.)
| | - Florence David
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France; (L.M.); (C.B.); (F.D.); (C.-A.M.)
| | - Carole-Ann Metro
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France; (L.M.); (C.B.); (F.D.); (C.-A.M.)
| | - Laurent Dortet
- INSERM UMR1184-Team RESIST, Faculty of Medicine, Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France;
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France; (L.M.); (C.B.); (F.D.); (C.-A.M.)
- Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, 94270 Le Kremlin-Bicêtre, France
- Correspondence: ; Tel.: +33-(0)-1-45216332
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Dembicka KM, Powell J, O'Connell NH, Hennessy N, Brennan G, Dunne CP. Prevalence of linezolid-resistant organisms among patients admitted to a tertiary hospital for critical care or dialysis. Ir J Med Sci 2021; 191:1745-1750. [PMID: 34505273 PMCID: PMC9308576 DOI: 10.1007/s11845-021-02773-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Linezolid is an oxazolidinone antimicrobial regarded as a "last resort" antimicrobial, used typically for treatment of Gram-positive bacterial infections. It is acknowledged that prevalence of resistance to linezolid is increasing in Europe. In Ireland, a number of outbreaks of linezolid-resistant isolates have been reported, including an outbreak at the location for this study, the Intensive Care Unit (ICU) of University Hospital Limerick (UHL). METHODS The Chromagar™ Lin-R selective medium was validated using a panel of linezolid-sensitive and linezolid-resistant strains. Subsequently, the prevalence exercise focused on a convenience sample of patients (n = 159) in critical care wards, ICU (n = 23) and High-Dependency Unit (HDU, n = 51), in addition to patients undergoing dialysis therapy (n = 77). Eight additional patients had specimens collected when attending more than one location. Growth on Chromagar™ Lin-R agar was followed by drug sensitivity testing by disc diffusion and minimum inhibitory concentration (MIC) testing. RESULTS A validation exercise was performed on 23 isolates: seven target and sixteen non-target organisms. Isolates performed as intended (100% sensitivity, 100% specificity). For the prevalence study, of 398 tests, 40 resulted in growth of non-target organisms (specificity approx. 90%). A sole patient (1/159) was identified as colonized by a linezolid-resistant Staphylococcus epidermidis, a prevalence of 0.63%. Molecular investigation confirmed presence of the G2576T mutation in the 23S rRNA. CONCLUSION While this point prevalence study identified extremely low carriage of linezolid-resistant bacteria, it remains prudent to maintain vigilance as reports of outbreaks associated with linezolid-resistant S. epidermidis (LRSE) in European critical care units are increasing.
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Affiliation(s)
| | - James Powell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Nuala H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland.,Centre for Interventions in Infection, Inflammation & Immunity (4I) and School of Medicine, University of Limerick, Limerick, Ireland
| | - Noreen Hennessy
- Public Health Laboratory, Raheen Business Park, Limerick, Ireland
| | - Grainne Brennan
- National MRSA Reference Laboratory, St James's Hospital, Dublin, Ireland
| | - Colum P Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4I) and School of Medicine, University of Limerick, Limerick, Ireland.
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