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15 July 2006

Volume 43, Number 2
Clinical Infectious Diseases 2006;43:165–171
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4302-0006$15.00
DOI: 10.1086/505114
MAJOR ARTICLE

Epidemiological Profile of Linezolid‐Resistant Coagulase‐Negative Staphylococci

Brian A. Potoski,1,3,4

Jennifer Adams,3

Lloyd Clarke,4

Kathleen Shutt,3

Peter K. Linden,2

Carla Baxter,5

A. William Pasculle,5

Blair Capitano,1,3,4

Anton Y. Peleg,3

Dora Szabo,3,a and

David L. Paterson3,4

Departments of 1Pharmacy and Therapeutics and 2Critical Care Medicine, 3Division of Infectious Diseases, 4Antibiotic Management Program, and 5Clinical Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Background.Surveillance studies have shown that <0.1% of coagulase‐negative staphylococci are linezolid resistant; however, at our institution, 4% of such organisms were found to be resistant. We investigated the risk factors for and the epidemiological profile of linezolid‐resistant coagulase‐negative staphylococci.

Methods.Susceptibility testing and pulsed‐field gel electrophoresis were performed to analyze the genetic relatedness of both linezolid‐resistant and linezolid‐susceptible isolates. Clinical data were retrieved from medical records, and a case‐case‐control study was performed to identify unique risk factors for linezolid resistance.

Results.Isolates recovered from 25 patients with linezolid‐resistant coagulase‐negative staphylococci were examined; all but 1 of the isolates were identified as Staphylococcus epidermidis, and all but 1 had a minimum inhibitory concentration of linezolid of >256 μg/mL. Pulsed‐field gel electrophoresis showed that 21 (84%) of 25 linezolid‐resistant isolates exhibited genetic relatedness, whereas linezolid‐susceptible isolates were of diverse clones. Unique, independent predictors of linezolid resistance included receipt of linezolid in the 3 months preceding isolation of the coagulase‐negative staphylococci (odds ratio, 20.6; 95% confidence interval, 5.8–73.0).

Conclusion.Linezolid‐resistant coagulase‐negative staphylococci have emerged at our institution and are predominately of a single clone. We believe that the most likely scenario to explain this emergence is that person‐to‐person spread of linezolid‐resistant coagulase‐negative staphylococci led to establishment of skin colonization with the strain. Subsequent use of linezolid was followed by selection of the linezolid‐resistant strain, which then became the dominant skin flora. The potential for a parallel scenario involving clonal dissemination followed by selection of linezolid‐resistant methicillin‐resistant Staphylococcus aureus is a real possibility.

Received 22 December 2005; accepted 20 March 2006; electronically published 5 June 2006.

Reprints or correspondence: Dr. David L. Paterson, Div. of Infectious Diseases, Ste. 3A, Falk Medical Bldg., 3601 5th Ave., Pittsburgh, PA 15213 ().

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  • Present affiliation: Semmelweis University, Budapest, Hungary.

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