Robert Koch Institute, Department of Infectious Diseases, National Centre for Staphylococci and Enterococci, Wernigerode, Germany.
Laboratory of Clinical Microbiology, ATTIKON University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
J Antimicrob Chemother. 2018 May 1;73(5):1181-1184. doi: 10.1093/jac/dkx524.
Linezolid-resistant Staphylococcus epidermidis (LRSE) and linezolid-dependent ST22 strains have been shown to predominate in tertiary care facilities all over Greece. We report herein the dissemination of ST22 but also ST2, ST5 and ST168 linezolid-dependent LRSE clones in four unrelated German hospitals.
Fourteen LRSE clinical isolates recovered during 2012-14 from five distantly located German hospitals were tested by for MIC determination broth microdilution and Etest, PCR/sequencing for cfr and for mutations in 23S rRNA, rplC, rplD and rplV genes, MLST, PFGE and growth curves without and with linezolid at 16 and 32 mg/L.
Most (11, 78.6%) isolates had linezolid MICs >256 mg/L. Five isolates carried the cfr gene. Eight isolates belonged to ST22, two isolates each to ST168 and ST2 and one isolate each to ST5 and ST23. Ten isolates [seven belonging to ST22 and one to each of ST2, ST5 and ST168; all these STs belong to clonal complex (CC) 5] exhibited linezolid-dependent growth, growing significantly faster in linezolid-containing broth. Four isolates were non-dependent (one belonging to each of ST22, ST2, ST23 and ST168). Four isolates came from three different hospitals, whereas four and six isolates were recovered during outbreaks of LRSE in two distinct hospitals.
The multi-clonal dissemination of CC5 linezolid-dependent LRSE throughout German hospitals along with the clonal expansion of ST22 linezolid-dependent LRSE in Greek hospitals is of particular concern. It is plausible that this characteristic is inherent and provides a selective advantage to CC5 LRSE under linezolid pressure, contributing to their dissemination throughout hospitals in these countries.
耐(linezolid-resistant)利奈唑胺表皮葡萄球菌（LRSE）和依赖(linezolid-dependent)ST22 菌株已在希腊各地的三级医疗机构中占主导地位。我们在此报告，在四家无关联的德国医院中，ST22 但也有 ST2、ST5 和 ST168 依赖利奈唑胺的 LRSE 克隆的传播。
2012-2014 年，从德国的五家地理位置较远的医院中分离出 14 株 LRSE 临床分离株，通过肉汤微量稀释法和 Etest 测定 MIC，PCR/测序检测 cfr 基因和 23S rRNA、rplC、rplD 和 rplV 基因的突变，MLST、PFGE 和生长曲线，不添加和添加 16 和 32mg/L 利奈唑胺。
大多数（11，78.6%）分离株的利奈唑胺 MICs>256mg/L。5 株分离株携带 cfr 基因。8 株分离株属于 ST22，2 株分离株分别属于 ST168 和 ST2，1 株分离株分别属于 ST5 和 ST23。10 株[7 株属于 ST22，1 株属于 ST2、ST5 和 ST168；所有这些 ST 都属于克隆群（CC）5]表现出依赖利奈唑胺的生长，在含利奈唑胺的肉汤中生长速度明显更快。4 株分离株为非依赖性（分别属于 ST22、ST2、ST23 和 ST168）。4 株分离株来自 3 家不同的医院，而 4 株和 6 株分离株分别在两家不同医院的 LRSE 暴发中被分离。
德国各医院中 CC5 依赖利奈唑胺的 LRSE 的多克隆传播以及希腊各医院中 ST22 依赖利奈唑胺的 LRSE 的克隆扩展特别令人关注。这种特性很可能是内在的，并在利奈唑胺压力下为 CC5 LRSE 提供了选择性优势，导致它们在这些国家的医院中传播。
