万古霉素过敏患者中耐利奈唑胺所致的器械相关脑膜炎
Device-Associated Meningitis by Linezolid-Resistant in a Vancomycin- Hypersensitive Patient.
作者信息
Vijayan Priya, Srinivas Dwarakanath, Siddaiah Nagarathna, Bahubali Veena Kumari Haradara
机构信息
Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
出版信息
J Neurosci Rural Pract. 2019 Oct;10(4):718-720. doi: 10.1055/s-0039-3399599. Epub 2019 Dec 11.
Postsurgical device-related meningitis caused by multidrug-resistant coagulase-negative staphylococci often complicates the treatment options. We report a rare and, to our knowledge, the first clinical case report of drain-associated meningitis caused by methicillin- and linezolid-resistant following linezolid therapy in a vancomycin-hypersensitive patient subsequently treated with cotrimoxazole, resulting in clinical improvement. The molecular mechanisms responsible for linezolid resistance were found to be the presence of G2576T mutation in domain V of 23srRNA region, which often arises during linezolid usage and also carriage of gene, which promotes resistance independent of antibiotic pressure. We emphasize on monitoring the rational use of linezolid to avoid the spread of resistance and also comprehensive perioperative care to prevent health care-associated infection.
由耐多药凝固酶阴性葡萄球菌引起的术后装置相关脑膜炎常常使治疗选择变得复杂。我们报告了一例罕见的、据我们所知首例的临床病例，一名对万古霉素过敏的患者在接受利奈唑胺治疗后发生了由耐甲氧西林和耐利奈唑胺的菌株引起的引流管相关脑膜炎，随后用复方新诺明治疗，临床症状改善。发现导致利奈唑胺耐药的分子机制是23srRNA区域V结构域中存在G2576T突变，该突变常在使用利奈唑胺期间出现，同时还存在 基因的携带，其促进耐药性且不依赖于抗生素压力。我们强调监测利奈唑胺的合理使用以避免耐药性传播，以及全面的围手术期护理以预防医疗保健相关感染。
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