Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, 66421, Homburg, Germany.
Department of Anesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, Homburg, Germany.
Antimicrob Resist Infect Control. 2021 Jun 30;10(1):99. doi: 10.1186/s13756-021-00970-3.
The unrestricted use of linezolid has been linked to the emergence of linezolid-resistant Staphylococcus epidermidis (LRSE). We report the effects of combined antibiotic stewardship and infection control measures on the spread of LRSE in an intensive care unit (ICU).
Microbiological data were reviewed to identify all LRSE detected in clinical samples at an ICU in southwest Germany. Quantitative data on the use of antibiotics with Gram-positive coverage were obtained in defined daily doses (DDD) per 100 patient-days (PD). In addition to infection control measures, an antibiotic stewardship intervention was started in May 2019, focusing on linezolid restriction and promoting vancomycin, wherever needed. We compared data from the pre-intervention period (May 2018-April 2019) to the post-intervention period (May 2019-April 2020). Whole-genome sequencing (WGS) was performed to determine the genetic relatedness of LRSE isolates.
In the pre-intervention period, LRSE were isolated from 31 patients (17 in blood cultures). The average consumption of linezolid and daptomycin decreased from 7.5 DDD/100 PD and 12.3 DDD/100 PD per month in the pre-intervention period to 2.5 DDD/100 PD and 5.7 DDD/100 PD per month in the post-intervention period (p = 0.0022 and 0.0205), respectively. Conversely, vancomycin consumption increased from 0.2 DDD/100 PD per month to 4.7 DDD/100 PD per month (p < 0.0001). In the post-intervention period, LRSE were detected in 6 patients (4 in blood cultures) (p = 0.0065). WGS revealed the predominance of one single clone.
Complementing infection control measures by targeted antibiotic stewardship interventions was beneficial in containing the spread of LRSE in an ICU.
利奈唑胺的无限制使用与耐利奈唑胺表皮葡萄球菌（LRSE）的出现有关。我们报告了在重症监护病房（ICU）中，联合抗生素管理和感染控制措施对 LRSE 传播的影响。
对德国西南部一家 ICU 临床样本中检测到的所有 LRSE 进行微生物学数据分析。以每 100 个患者日（PD）的限定日剂量（DDD）定量获得具有革兰氏阳性覆盖的抗生素使用数据。除了感染控制措施外，还于 2019 年 5 月开始实施抗生素管理干预，重点限制利奈唑胺，并在需要时推广万古霉素。我们将干预前（2018 年 5 月至 2019 年 4 月）和干预后（2019 年 5 月至 2020 年 4 月）的数据进行比较。对耐利奈唑胺表皮葡萄球菌分离株进行全基因组测序（WGS），以确定其遗传相关性。
在干预前期间，从 31 名患者（血培养中 17 名）中分离出 LRSE。利奈唑胺和达托霉素的平均消耗量从干预前期间每月 7.5 DDD/100 PD 和 12.3 DDD/100 PD 降至干预后期间每月 2.5 DDD/100 PD 和 5.7 DDD/100 PD（p=0.0022 和 0.0205）。相反，万古霉素的消耗量从每月 0.2 DDD/100 PD 增加到每月 4.7 DDD/100 PD（p<0.0001）。在干预后期间，在 6 名患者（血培养中 4 名）中检测到 LRSE（p=0.0065）。WGS 显示主要是一个单一的克隆。
通过靶向抗生素管理干预措施，在感染控制措施的基础上进行补充，有助于遏制 ICU 中 LRSE 的传播。
