Abstract
BackgroundThe unrestricted use of linezolid has been linked to the emergence of linezolid-resistant Staphylococcus epidermidis (LRSE). We report the effects of combined antibiotic stewardship and infection control measures on the spread of LRSE in an intensive care unit (ICU).MethodsMicrobiological data were reviewed to identify all LRSE detected in clinical samples at an ICU in southwest Germany. Quantitative data on the use of antibiotics with Gram-positive coverage were obtained in defined daily doses (DDD) per 100 patient-days (PD). In addition to infection control measures, an antibiotic stewardship intervention was started in May 2019, focusing on linezolid restriction and promoting vancomycin, wherever needed. We compared data from the pre-intervention period (May 2018–April 2019) to the post-intervention period (May 2019–April 2020). Whole-genome sequencing (WGS) was performed to determine the genetic relatedness of LRSE isolates.ResultsIn the pre-intervention period, LRSE were isolated from 31 patients (17 in blood cultures). The average consumption of linezolid and daptomycin decreased from 7.5 DDD/100 PD and 12.3 DDD/100 PD per month in the pre-intervention period to 2.5 DDD/100 PD and 5.7 DDD/100 PD per month in the post-intervention period (p = 0.0022 and 0.0205), respectively. Conversely, vancomycin consumption increased from 0.2 DDD/100 PD per month to 4.7 DDD/100 PD per month (p < 0.0001). In the post-intervention period, LRSE were detected in 6 patients (4 in blood cultures) (p = 0.0065). WGS revealed the predominance of one single clone.ConclusionsComplementing infection control measures by targeted antibiotic stewardship interventions was beneficial in containing the spread of LRSE in an ICU.
Highlights
The unrestricted use of linezolid has been linked to the emergence of linezolid-resistant Staphylococcus epidermidis (LRSE)
While vancomycin has remained the drug of choice for infections caused by methicillinresistant Staphylococcus aureus (MRSA), linezolid has gained importance as an alternative, especially in MRSA pneumonia, and in infections caused by vancomycinresistant enterococci (VRE) [6]
1668 156 (9.4%) 5.6 5.3 10.7 p-values of significant differences are shown in bold LRSE linezolid-resistant Staphylococcus epidermidis, Interquartile range (IQR) interquartile range, DDD defined daily doses, PD patient-days, no. number
Summary
The unrestricted use of linezolid has been linked to the emergence of linezolid-resistant Staphylococcus epidermidis (LRSE). Treatment of clinically relevant S. epidermidis infections frequently requires the use of glycopeptides, oxazolidinones or lipopeptide antibiotics, as resistance to beta-lactams is widespread among S. epidermidis strains [4]. The oxazolidinone antibiotic linezolid acts as an inhibitor of bacterial protein synthesis, and was approved for the treatment of infections caused by Gram-positive organisms in 2000 [5]. While vancomycin has remained the drug of choice for infections caused by methicillinresistant Staphylococcus aureus (MRSA), linezolid has gained importance as an alternative, especially in MRSA pneumonia, and in infections caused by vancomycinresistant enterococci (VRE) [6]. There is no associated nephrotoxicity related to the use of linezolid, making it a favoured antibiotic especially in critically ill patients with impaired renal function. The nephrotoxicity encountered with the use of vancomycin requires stringent therapeutic drug monitoring, to ensure efficient drug levels while at the same time avoiding toxicities
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
