Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; Department of Infection Prevention and Control, University Hospital Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation and Immunity, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland.
J Hosp Infect. 2015 Aug;90(4):316-21. doi: 10.1016/j.jhin.2014.12.013. Epub 2015 Jan 13.
To report the first Irish outbreak of cfr-mediated linezolid-resistant Staphylococcus epidermidis.
Linezolid-resistant S. epidermidis isolated at University Hospital Limerick from four blood cultures, one wound and four screening swabs (from nine patients) between April and June 2013 were characterized by pulsed-field gel electrophoresis (PFGE), multi-locus sequence typing (MLST) and staphylococcal cassette chromosome (SCCmec) typing. Antibiotic susceptibilities were determined according to the guidelines of the British Society for Antimicrobial Chemotherapy. The outbreak was controlled through prohibiting prescription and use of linezolid, adherence to infection prevention and control practices, enhanced environmental cleaning, isolation of affected patients, and hospital-wide education programmes.
PFGE showed that all nine isolates represented a single clonal strain. MLST showed that they belonged to ST2, and SCCmec typing showed that they encoded a variant of SCCmecIII. All nine isolates were cfr positive, and eight isolates were positive for the G2576T 23S rRNA mutation commonly associated with linezolid resistance. Isolates exhibited multiple antibiotic resistances (i.e. linezolid, gentamicin, methicillin, clindamycin, ciprofloxacin, fusidic acid and rifampicin). The adopted infection prevention intervention was effective, and the outbreak was limited to the affected intensive care unit.
This is the first documented outbreak of cfr-mediated linezolid-resistant S. epidermidis in the Republic of Ireland. Despite this, and due to existing outbreak management protocols, the responsible micro-organism and source were identified efficiently. However, it became apparent that staff knowledge of antimicrobial susceptibilities and appropriate hygiene practices were suboptimal at the time of the outbreak, and that educational interventions (and re-inforcement) are necessary to avoid occurrence of antimicrobial resistance and outbreaks such as reported here.
报告爱尔兰首例 cfr 介导的利奈唑胺耐药表皮葡萄球菌爆发。
2013 年 4 月至 6 月，利默里克大学医院从 4 份血培养物、1 份伤口和 4 份筛查拭子（来自 9 名患者）中分离出耐利奈唑胺的表皮葡萄球菌，采用脉冲场凝胶电泳（PFGE）、多位点序列分型（MLST）和葡萄球菌盒式染色体（SCCmec）分型进行特征分析。根据英国抗菌化疗学会的指南测定抗生素敏感性。通过禁止开处方和使用利奈唑胺、遵守感染预防和控制措施、加强环境清洁、隔离受影响的患者以及开展全院教育计划来控制疫情。
PFGE 显示，所有 9 株分离株均代表单一克隆株。MLST 显示它们属于 ST2，SCCmec 分型显示它们编码 SCCmecIII 的变体。9 株分离株均为 cfr 阳性，8 株分离株携带与利奈唑胺耐药相关的常见 23S rRNA 突变 G2576T。分离株表现出多种抗生素耐药性（即利奈唑胺、庆大霉素、甲氧西林、克林霉素、环丙沙星、夫西地酸和利福平）。所采取的感染预防干预措施有效，疫情仅限于受影响的重症监护病房。
这是爱尔兰首例 cfr 介导的利奈唑胺耐药表皮葡萄球菌爆发。尽管如此，并且由于存在爆发管理协议，负责的微生物和来源很快被识别。然而，在疫情发生时，员工对抗生素敏感性和适当卫生习惯的了解显然不足，需要进行教育干预（和强化），以避免出现这里报告的抗生素耐药性和爆发。
