Emergence and long-lasting persistence of linezolid-resistant Enterococcus faecium-ST117 in an oncohematologic patient after a nine-day course of linezolid

Microb Drug Resist. 2014 Feb;20(1):17-21. doi: 10.1089/mdr.2013.0034. Epub 2013 Aug 29.

Abstract

We report the emergence and long-lasting persistence of linezolid resistance in an ampicillin-resistant Enterococcus faecium strain in the intestine of a neutropenic oncohematologic patient receiving chemotherapy. The patient was first colonized by an epidemic ampicillin-resistant E. faecium (ARE)-ST117 clustering into lineage 78. This clone exhibited resistance to levofloxacin, erythromycin and high-level resistance to streptomycin and gentamicin. After receiving treatment with several broad spectrum antibiotics for febrile neutropenia, a 9-day course of oral linezolid was administered once the patient developed bacteraemia by the same ARE colonizing clone. Linezolid-resistant ARE was detected 17 days later in the follow-up fecal samples and persisted 41 days after suppression of linezolid therapy. Resistance to linezolid was associated with G2576T transversion in the 23S rRNA and the presence of cfr gene was not detected. The persistence of G2576T-ARE strains, especially in oncohematologic patients with injured intestinal membranes, could increase the risk of bacteraemia.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetamides / therapeutic use*
  • Acute Disease
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Antineoplastic Agents / therapeutic use
  • Drug Resistance, Multiple, Bacterial / drug effects
  • Drug Resistance, Multiple, Bacterial / genetics*
  • Enterococcus faecium / drug effects
  • Enterococcus faecium / genetics*
  • Enterococcus faecium / pathogenicity
  • Gram-Positive Bacterial Infections / complications
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / microbiology
  • Gram-Positive Bacterial Infections / pathology
  • Humans
  • Leukemia / complications
  • Leukemia / drug therapy
  • Leukemia / microbiology*
  • Leukemia / pathology
  • Linezolid
  • Male
  • Neutropenia / complications
  • Neutropenia / drug therapy
  • Neutropenia / microbiology
  • Neutropenia / pathology
  • Oxazolidinones / therapeutic use*
  • Point Mutation*
  • RNA, Ribosomal, 23S / genetics*

Substances

  • Acetamides
  • Anti-Bacterial Agents
  • Antineoplastic Agents
  • Oxazolidinones
  • RNA, Ribosomal, 23S
  • Linezolid