Institute for Medical Microbiology, Virology and Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Antibiotic Stewardship Team, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Institute for Medical Microbiology, Virology and Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Int J Med Microbiol. 2021 Feb;311(2):151477. doi: 10.1016/j.ijmm.2021.151477. Epub 2021 Jan 27.
We aim to describe the epidemiological, clinical and microbiological characteristics of the linezolid- and vancomycin- resistant Enterococcus faecium (LVRE) in a tertiary care hospital in Germany.
We conducted a retrospective analysis of 196 LVRE cases observed from 1st January 2012 to 31th December 2018. Patients' medical charts were reviewed and available LVRE (n = 102) were subjected to whole-genome-sequencing. Antibiotic consumption was measured in defined daily dose (DDD)/100 bed-days (BD).
The prevalence of LVRE isolates among VRE was 6.3 % in 2018. Most patients had an onco-hematological disease (134/196, 68.4 %). From 2012-2018 an increase of +356.7 % of linezolid defined daily dose/100 bed-days was observed. In 71.4 % (90/126, 70 missing values) of the patients, linezolid was prescribed in the previous 6 months. The median exposure to linezolid was 15 days (Interquartile, IQR 9-23). 42/196 (21.4 %) patients had an LVRE-related infection with an overall 30-day mortality rate of 33 %. In 121/196 (61.7 %) patients, linezolid-susceptible VREfm were isolated before LVRE, suggesting secondary acquisition of linezolid resistance. Genetic analysis revealed that most isolates belonged to ST117 (64/102 available isolates, 62.7 %). The G2576T 23S rDNA mutation was identified as the most common resistance mechanism (96/102, 94.1 %). poxtA was identified in two isolates, while cfr, and optrA were not detected.
Incidence of LVRE related to 23S rDNA mutations is rising and probably associated with antibiotic consumption. Restrictions in the use of linezolid may be needed in order to retain therapeutic options in VRE.
描述德国一家三级保健医院中利奈唑胺和万古霉素耐药粪肠球菌（LVRE）的流行病学、临床和微生物学特征。
我们对 2012 年 1 月 1 日至 2018 年 12 月 31 日期间观察到的 196 例 LVRE 病例进行了回顾性分析。查阅了患者的病历，并对可获得的 LVRE（n=102）进行了全基因组测序。以每 100 个床位日的限定日剂量（DDD）来衡量抗生素的消耗。
2018 年 LVRE 分离株在 VRE 中的检出率为 6.3%。大多数患者患有肿瘤血液病（134/196，102 例缺失值）。2012-2018 年，利奈唑胺的 DDD/100 床日增加了+356.7%。在 71.4%（90/126，102 例缺失值）的患者中，在过去 6 个月内开具了利奈唑胺。利奈唑胺暴露中位数为 15 天（四分位距，IQR 9-23）。42/196（102 例缺失值）例患者发生 LVRE 相关感染，30 天总死亡率为 33%。在 196 例患者中，121 例（61.7%）分离出利奈唑胺敏感屎肠球菌，提示继发获得利奈唑胺耐药性。遗传分析显示，大多数分离株属于 ST117（64/102 株，62.7%）。23S rDNA 基因 G2576T 突变是最常见的耐药机制（96/102，94.1%）。在 2 株分离株中发现了 poxtA，而未检测到 cfr 和 optrA。
与 23S rDNA 突变相关的 LVRE 发生率正在上升，可能与抗生素的使用有关。为了保留对 VRE 的治疗选择，可能需要限制利奈唑胺的使用。
