Anderegg Tamara R, Sader Helio S, Fritsche Thomas R, Ross James E, Jones Ronald N
JMI Laboratories, Inc., 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317, USA.
Int J Antimicrob Agents. 2005 Jul;26(1):13-21. doi: 10.1016/j.ijantimicag.2005.02.019.
Linezolid is an important oxazolidinone antimicrobial for the treatment of infections caused by Gram-positive cocci, especially vancomycin-resistant enterococci and oxacillin-resistant Staphylococcus aureus (ORSA). Since its introduction, however, ribosomal mutations have been detected that produce resistance; thus, longitudinal surveillance remains necessary to monitor for emerging resistance in all geographic areas of oxazolidinone use. The 2003 Zyvox Annual Appraisal of Potency and Spectrum (ZAAPS) Program compared linezolid minimum inhibitory concentration (MIC) results with 13-15 comparator antimicrobial agents (8089 isolates) and also with results from an earlier surveillance period (2002). Sampling institutions in the United States of America (USA), Canada, Europe (seven nations), South America (three nations) and the Asia-Pacific (three nations) referred 200 Gram-positive cocci to the central laboratory for MIC processing and identification confirmation. Linezolid resistance (MIC > or = 8 mg/L) was established by alternative susceptibility testing methods as well as by ribosomal target characterisation. Concurrent drug use data were collected. Linezolid activity against the six major organism groups did not vary between years or geographic areas. In contrast, penicillin resistance increased 2% in Streptococcus pneumoniae; macrolide resistance was stable among beta-haemolytic streptococci (19-21%), but increased in S. pneumoniae (+2%); ORSA rates increased 4%; and vancomycin resistance in enterococci was present, but varied markedly by region. Non-clonal linezolid-resistant isolates were detected, each having the same G2576U 23S rRNA target mutation. Furthermore, the first linezolid-resistant, non-USA isolate (S. aureus in Greece) was observed, apparently related to linezolid use. In 2003, near complete activity for linezolid against Gram-positive isolates was again documented (99.93% susceptible) in the ZAAPS Program. Rare linezolid-resistant isolates were identified among enterococci, limited to USA strains. Limited correlations of linezolid resistance to drug use continues, with an average consumption rate of 0.63DDD/100 patient days (a 50% increase since 2002), and indicates the important role of hospital hygiene practice in preventing the dissemination of oxazolidinone resistances, should they be detected.
利奈唑胺是一种重要的恶唑烷酮类抗菌药物，用于治疗革兰氏阳性球菌引起的感染，尤其是耐万古霉素肠球菌和耐苯唑西林金黄色葡萄球菌（ORSA）。然而，自其引入以来，已检测到产生耐药性的核糖体突变；因此，仍需进行纵向监测，以监测恶唑烷酮类药物使用的所有地理区域中出现的耐药性。2003年的Zyvox年度效力和谱评估（ZAAPS）计划将利奈唑胺的最低抑菌浓度（MIC）结果与13 - 15种对照抗菌药物（8089株分离菌）进行了比较，还与早期监测期（2002年）的结果进行了比较。美国、加拿大、欧洲（七个国家）、南美洲（三个国家）和亚太地区（三个国家）的抽样机构将200株革兰氏阳性球菌送交中央实验室进行MIC检测和鉴定确认。通过替代药敏试验方法以及核糖体靶点特征鉴定确定了利奈唑胺耐药性（MIC≥8mg/L）。同时收集了药物使用数据。利奈唑胺对六大主要菌群的活性在不同年份和地理区域之间没有差异。相比之下，肺炎链球菌的青霉素耐药性增加了2%；β溶血性链球菌中的大环内酯类耐药性保持稳定（19 - 21%），但在肺炎链球菌中有所增加（+2%）；ORSA发生率增加了4%；肠球菌中的万古霉素耐药性存在，但因地区而异。检测到非克隆性利奈唑胺耐药分离株，每株都有相同的G2576U 23S rRNA靶点突变。此外，观察到首例非美国的利奈唑胺耐药分离株（希腊的金黄色葡萄球菌），显然与利奈唑胺的使用有关。2003年，ZAAPS计划再次记录了利奈唑胺对革兰氏阳性分离株的近乎完全活性（99.93%敏感）。在肠球菌中鉴定出罕见的利奈唑胺耐药分离株，仅限于美国菌株。利奈唑胺耐药性与药物使用之间的相关性仍然有限，平均消耗率为0.63DDD/100患者日（自2002年以来增加了50%），这表明医院卫生实践在预防恶唑烷酮类耐药性传播（如果检测到）方面的重要作用。
