Long-lasting successful dissemination of resistance to oxazolidinones in MDR Staphylococcus epidermidis clinical isolates in a tertiary care hospital in France
In: ISSN: 0305-7453, 2018
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academicJournal
Zugriff:
International audience ; Objectives: Patient-and procedure-related changes in modern medicine have turned CoNS into one of the major nosocomial pathogens. Treatments of CoNS infections are challenging owing to the large proportion of MDR strains and oxazolidinones often remain the last active antimicrobial molecules. Here, we have investigated a long-lasting outbreak (2010-13) due to methicillin-and linezolid-resistant (LR) CoNS (n " 168), involving 72 carriers and 49 infected patients. Methods: Antimicrobial susceptibilities were tested by the disc diffusion method and MICs were determined by broth microdilution or Etest. The clonal relationship of LR Staphylococcus epidermidis (LRSE) was first determined using a semi-automated repetitive element palindromic PCR (rep-PCR) method. Then, WGS was performed on all cfr-positive LRSE (n " 30) and LRSE isolates representative of each rep-PCR-defined clone (n " 17). Self-transferability of cfr-carrying plasmids was analysed by filter-mating experiments. Results: This outbreak was caused by the dissemination of three clones (ST2, ST5 and ST22) of LRSE. In these clones, linezolid resistance was caused by (i) mutations in the chromosome-located genes encoding the 23S RNA and L3 and L4 ribosomal proteins, but also by (ii) the dissemination of two different self-conjugative plasmids carrying the cfr gene encoding a 23S RNA methylase. By monitoring linezolid prescriptions in two neighbouring hospitals, we highlighted that the spread of LR-CoNS was strongly associated with linezolid use. Conclusions: Physicians should be aware that plasmid-encoded linezolid resistance has started to disseminate among CoNS and that rational use of oxazolidinones is critical to preserve these molecules as efficient treatment options for MDR Gram-positive pathogens.
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Long-lasting successful dissemination of resistance to oxazolidinones in MDR Staphylococcus epidermidis clinical isolates in a tertiary care hospital in France
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Autor/in / Beteiligte Person: | Dortet, Laurent ; Glaser, Philippe ; Kassis-Chikhani, Najiby ; Girlich, Delphine ; Ichai, Philippe ; Boudon, Marc ; Samuel, Didier ; Creton, Elodie ; Imanci, Dilek ; Bonnin, Rémy ; Fortineau, Nicolas ; Naas, Thierry ; AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre) ; Centre National de Référence Associé de la Résistance aux Antibiotiques Hôpital Bicêtre AP-HP (CNRARA/Service de Microbiologie) ; Ecologie et Evolution de la Résistance aux Antibiotiques / Ecology and Evolution of Antibiotics Resistance (EERA) ; Université Paris-Sud - Paris 11 (UP11)-Institut Pasteur Paris (IP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS) ; Service de Bactériologie-Virologie-Hygiène ; Hôpital de Bicêtre ; CHU Saint-Antoine AP-HP ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU) ; Centre Hospitalier Universitaire Paul Brousse, Villejuif, France ; Hôpital Paul Brousse ; Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse ; Structure, Dynamique, Fonction Et Expression Des Beta-Lactamases À Large Spectre ; Université Paris-Sud - Paris 11 - Faculté de médecine (UP11 UFR Médecine) ; Université Paris-Sud - Paris 11 (UP11)-Université Paris-Sud - Paris 11 (UP11)-Centre National de Référence de la Résistance aux Antibiotiques (CNR) ; Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon) ; Centre Hépato-Biliaire Hôpital Paul Brousse (CHB) ; Hôpital Paul Brousse-Assistance Publique - Hôpitaux de Paris ; Physiopathologie et traitement des maladies du foie ; Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM) ; Service de Génétique Moléculaire Pharmacogénétique et Hormonologie CHU Bicêtre ; This work was supported by the Assistance Publique – Hôpitaux de Paris, a grant from the Universite´ Paris Sud (EA 7361), the LabEx LERMIT supported by a grant from the French National Research Agency (ANR-10-LABX-33) and the LabEx IBEID. ; ANR-10-LABX-0062,IBEID,Integrative Biology of Emerging Infectious Diseases(2010) ; ANR-11-IDEX-0003,IPS,Idex Paris-Saclay(2011) |
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Zeitschrift: | ISSN: 0305-7453, 2018 |
Veröffentlichung: | HAL CCSD ; Oxford University Press (OUP), 2018 |
Medientyp: | academicJournal |
DOI: | 10.1093/jac/dkx370 |
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