Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India.
Department of Molecular Biology and Genetic Engineering, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, Punjab, 144422, India.
Eur J Clin Microbiol Infect Dis. 2024 Apr;43(4):767-775. doi: 10.1007/s10096-024-04784-0. Epub 2024 Feb 19.
The aim of the study was to determine the resistance profile of linezolid-resistant Enterococcus faecium (LREfm) and to investigate risk factors and outcomes associated with LREfm infections.
A prospective case-control study was undertaken (2019 to 2022) and included 202 patients with LREfm infections (cases) and 200 controls with LSEfm infections. Clinical data was prospectively collected and analysed for risk factors and outcomes. Antimicrobial susceptibility was performed, and resistance profile was studied using WHOnet.
Risk factors associated with LREfm infection were site of infection UTI (OR 5.87, 95% CI 2.59-13.29, p ≤ 0.001), prior use of carbapenem (OR 2.85 95% CI 1.62-5.02, p ≤ 0.001) and linezolid (OR 10.13, 95% CI 4.13-24.82, p ≤ 0.001), use of central line (OR 5.54, 95% CI 2.35-13.09, p ≤ 0.001), urinary catheter (OR 0.29, 95% CI 0.12-0.70, p ≤ 0.001) and ventilation (OR 14.87, 95% CI 7.86-28.11, p ≤ 0.007). The hospital stay 8-14 days (< 0.001) prior to infection and the mortality rate (p = 0.003) were also significantly high among patients with LREfm infections. Linezolid and vancomycin resistance coexisted; further, MDR, XDR and PDR phenotypes were significantly higher among LREfm.
This study provided insight into epidemiology of MDR LREfm in a setting where linezolid use is high. The main drivers of infections with LREfm are multiple, including use of carbapenems and linezolid. Invasive procedures and increased hospital stay facilitate spread through breach in infection control practises. As therapeutic options are limited, ongoing surveillance of LREfm and VRE is critical to guide appropriate use of linezolid and infection control policies.
本研究旨在确定耐利奈唑胺屎肠球菌（LREfm）的耐药谱，并探讨与 LREfm 感染相关的危险因素和结局。
进行了一项前瞻性病例对照研究（2019 年至 2022 年），纳入了 202 例 LREfm 感染患者（病例）和 200 例 LSEfm 感染对照。前瞻性收集临床数据并进行危险因素和结局分析。进行了抗菌药物敏感性试验，并使用 WHOnet 研究耐药谱。
与 LREfm 感染相关的危险因素包括感染部位为尿路感染（UTI）（OR 5.87，95%CI 2.59-13.29，p≤0.001）、先前使用碳青霉烯类药物（OR 2.85，95%CI 1.62-5.02，p≤0.001）和利奈唑胺（OR 10.13，95%CI 4.13-24.82，p≤0.001）、使用中心静脉置管（OR 5.54，95%CI 2.35-13.09，p≤0.001）、导尿管（OR 0.29，95%CI 0.12-0.70，p≤0.001）和呼吸机（OR 14.87，95%CI 7.86-28.11，p≤0.007）。感染前住院时间为 8-14 天（<0.001）和死亡率（p=0.003）在 LREfm 感染患者中也显著较高。利奈唑胺和万古霉素耐药共存；此外，LREfm 中 MDR、XDR 和 PDR 表型显著更高。
本研究提供了在利奈唑胺使用较高的环境中耐多药 LREfm 流行病学的见解。LREfm 感染的主要驱动因素是多方面的，包括碳青霉烯类药物和利奈唑胺的使用。侵袭性操作和住院时间延长促进了感染控制措施破坏后的传播。由于治疗选择有限，对 LREfm 和 VRE 的持续监测对于指导利奈唑胺的合理使用和感染控制政策至关重要。
