Intensive Care Department, Hospital Clínico San Carlos and Universidad Complutense, 28040 Madrid, Spain.
JAMA. 2010 Jun 9;303(22):2260-4. doi: 10.1001/jama.2010.757.
Linezolid resistance is extremely uncommon in Staphylococcus aureus.
To report an outbreak with linezolid and methicillin-resistant S. aureus (LRSA) in an intensive care department and the effective control measures taken.
DESIGN, SETTING, AND PATIENTS: Outbreak study of consecutive critically ill patients colonized and/or infected with LRSA at an intensive care department of a 1000-bed tertiary care university teaching hospital in Madrid, Spain. Patients were placed under strict contact isolation. Daily updates of outbreak data and recommendations for the use of linezolid were issued. Extensive environmental sampling and screening of the hands of health care workers were performed.
Linezolid use and clinical and epidemiological characteristics and outcomes using minimal inhibitory concentrations, pulsed-field gel electrophoresis, and polymerase chain reaction of LRSA isolates.
Between April 13 and June 26, 2008, 12 patients with LRSA were identified. In 6 patients, LRSA caused ventilator-associated pneumonia and in 3 patients it caused bacteremia. Isolates were susceptible to trimethoprim-sulfamethoxazole, glycopeptides, tigecycline, and daptomycin. Genotyping identified 1 predominant clone and 3 other types. Cfr-mediated linezolid resistance was demonstrated in all isolates. Potential hospital staff carriers and environmental samples were negative except for one. Six patients died, 5 of them in the intensive care unit, with 1 death attributed to LRSA infection. Linezolid use decreased from 202 defined daily doses in April 2008 to 25 defined daily doses in July 2008. Between July 2008 and April 2010, no new cases have been identified in the weekly surveillance cultures or diagnostic samples.
The first clinical outbreak, to our knowledge, with LRSA mediated by the cfr gene developed at our center, was associated with nosocomial transmission and extensive usage of linezolid. Reduction of linezolid use and infection-control measures were associated with the termination of the outbreak.
耐(linezolid) 药物的金黄色葡萄球菌（Staphylococcus aureus）极为罕见。
报道在马德里一所拥有 1000 张病床的三级教学医院的重症监护病房中出现耐甲氧西林金黄色葡萄球菌（methicillin-resistant S. aureus，MRSA）和利奈唑胺（linezolid）的暴发情况，以及所采取的有效控制措施。
设计、地点和患者：对西班牙马德里一所拥有 1000 张病床的三级教学医院的重症监护病房中连续发生耐甲氧西林金黄色葡萄球菌（methicillin-resistant S. aureus，MRSA）定植或感染的危重患者进行暴发研究。患者被置于严格的接触隔离之下。每天更新暴发数据，并对利奈唑胺的使用提出建议。对环境进行了广泛的采样，并对医护人员的手部进行了筛查。
利奈唑胺的使用情况，以及耐甲氧西林金黄色葡萄球菌（methicillin-resistant S. aureus，MRSA）分离株的最低抑菌浓度（minimal inhibitory concentrations，MIC）、脉冲场凝胶电泳（pulsed-field gel electrophoresis，PFGE）和聚合酶链反应（polymerase chain reaction，PCR）的临床和流行病学特征和结果。
2008 年 4 月 13 日至 6 月 26 日，共发现 12 例耐利奈唑胺的金黄色葡萄球菌（linezolid-resistant S. aureus，LRSA）患者。6 例患者为呼吸机相关性肺炎（ventilator-associated pneumonia，VAP），3 例患者为菌血症。分离株对甲氧苄啶-磺胺甲恶唑、糖肽类、替加环素和达托霉素敏感。基因分型鉴定出 1 个主要克隆和 3 个其他类型。所有分离株均表现出 cfr 介导的利奈唑胺耐药。除 1 例外，潜在的医护人员携带者和环境样本均为阴性。6 例患者死亡，其中 5 例在重症监护病房，1 例死亡归因于耐利奈唑胺的金黄色葡萄球菌（linezolid-resistant S. aureus，LRSA）感染。2008 年 4 月，利奈唑胺的使用量为 202 日限定剂量（defined daily doses，DDD），2008 年 7 月降至 25 DDD。2008 年 7 月至 2010 年 4 月，每周的监测培养物或诊断样本均未发现新的病例。
我们中心首次报道了耐利奈唑胺的金黄色葡萄球菌（linezolid-resistant S. aureus，LRSA）与 cfr 基因相关的临床暴发，该暴发与医院内传播和广泛使用利奈唑胺有关。减少利奈唑胺的使用和感染控制措施与暴发的终止有关。
