Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Germ theory of disease wikipedia , lookup
Neonatal infection wikipedia , lookup
Transmission (medicine) wikipedia , lookup
Hygiene hypothesis wikipedia , lookup
Marburg virus disease wikipedia , lookup
Multiple sclerosis research wikipedia , lookup
Infection control wikipedia , lookup
Osteomyelitits Due to Linezolid-Resistant Staphylococcus epidermidis To the Editor—Described are the first reported cases of osteomyelitis due to linezolid-resistant Staphylococcus epidermidis. Case 1 was a 73-year-old woman with severe peripheral vascular disease and a recent diagnosis 6 months prior to admission of polymicrobial osteomyelitis of the left calcaneus, which had required multiple heel debridements, partial calcanectomy, and a skin grafting procedure. Linezolid and piperacillintazobactam were administered throughout her surgical course and for 6 weeks following her skin graft, at which time she was switched to linezolid monotherapy (linezolid was eventually discontinued 2 weeks prior to admission). She was admitted after a fall at home and was found to have purulent drainage from her left lower extremity graft with exposed bone. Imipenem-cilastatin was started empirically, and linezolid was added 2 days later. A deep wound swab obtained 2 days after admission isolated a coagulase-negative staphylococcus species that was not subjected to further laboratory testing. Surgical intervention was delayed due to initial patient refusal but was ultimately performed 2 weeks later. Bone cultures obtained intraoperatively isolated linezolid-resistant S. epidermidis (Table 1). The patient was eventually treated successfully with intravenous vancomycin and extensive plastic surgery. Case 2 was a 55-year-old man with chronically infected patellar hardware and associated left patellar osteomyelitis. He had been receiving linezolid for 6 weeks prior to admission from an outside prescriber following his most recent patellar debridement. He presented after a fall at his long-term acute care facility and was found to have a swollen left knee with purulent drainage. Culture of this drainage grew Table 1. Antimicrobial Susceptibilities of Linezolid-Resistant Staphylococcus epidermidis Isolatesa Minimum Inhibitory Concentration, lg/mL Antimicrobial Isolate 1 Isolate 2 Linezolidb .256 .256 Ceftriaxone .32 #8 Ciprofloxacin .2 .2 Clindamycin .4 Daptomycin Erythromycin #0.5 2 Gentamicin .8 .8 Levofloxacin .4 .4 Oxacillin .2 2 Penicillin .8 2 Quinupristin-dalfopristin 2 1 Rifampin #1 #1 Tetracycline Trimethoprim-sulfamethoxazole #4 2-38 #4 2-38 2 1 Vancomycin 1216 d CID 2012:54 (15 April) d 4 #0.5 2 a Performed with MicroScan combination breakpoint panels (Siemens Healthcare Diagnostics). b Confirmed by Etest (bioMèrieux). CORRESPONDENCE methicillin-resistant S. epidermidis susceptible to linezolid (minimum inhibitory concentration, #2 lg/mL). Bone cultures obtained during hardware removal 5 days later isolated 2 colony types of S. epidermidis: one that was linezolid susceptible and another that was linezolid resistant (Table 1). Due to a reported allergy to vancomycin, the patient was transitioned to daptomycin. He underwent 5 additional debridements in the month following hardware removal, and the linezolidresistant S. epidermidis strain was isolated from each of 4 debridements in which cultures were obtained. After his surgical course was completed and his wound was closed, he received an additional 6 weeks of daptomycin therapy with successful suppression of his infection. These are the first reports of osteomyelitis due to linezolid-resistant S. epidermidis. As in similar cases of linezolid-resistant staphylococcal infections, both patients received prolonged courses of linezolid in the setting of inadequate surgical debridement prior to isolation of a linezolid-resistant organism [1–9]. Although a detailed molecular analysis could not be performed, the antimicrobial susceptibility profiles of each isolate were different, suggesting that linezolid resistance developed independently during therapy (Table 1). Because of the deep-seated nature of osteomyelitis, the inconsistent concentrations of linezolid achievable in infected bone [10], and the frequency with which staphylococci cause osteomyelitis, we believe our experience could be replicated. The potential for Staphylococcus aureus to acquire linezolid resistance in a similar clinical setting is of particular concern. Linezolid should be reserved for patients failing or intolerant of conventional therapies for osteomyelitis. Notes Financial support. This work was supported by the use of resources at Utah Valley Regional Medical Center. Potential conflicts of interest. I. Z. A. has received speaker fees from Pfizer, Forest Pharmaceuticals, Merck, and Wyeth Pharmaceuticals. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Russell J. Benefield,1 George K. Hinde,2 and Igor Z. Abolnik3 1Department of Pharmacy, University of Utah Hospital, Salt Lake City; and 2Central Laboratory, Intermountain Healthcare, Murray; and 3Infectious Diseases, Central Utah Multispecialty Clinic, Provo, Utah a patient with left ventricular assist system. Scand J Infect Dis 2007; 39:463–5. 3. Peeters MJ, Sarria JC. Clinical characteristics of linezolid-resistant Staphylococcus aureus infections. Am J Med Sci 2005; 330:102–4. 4. Wilson P, Andrews JA, Charlesworth R, et al. Linezolid resistance in clinical isolates of Staphylococcus aureus. J Antimicrob Chemother 2003; 51:186–8. 5. Hill RL, Kearns AM, Nash J, et al. Linezolidresistant ST36 methicillin-resistant Staphylococcus aureus associated with prolonged linezolid treatment in two paediatric cystic fibrosis patients. J Antimicrob Chemother 2010; 65:442–5. 6. Tsiodras S, Gold HS, Sakoulas G, et al. Linezolid resistance in a clinical isolate of Staphylococcus aureus. Lancet 2001; 358:207–8. 7. Mulanovich VE, Huband MD, McCurdy SP, et al. Emergence of linezolid-resistant coagulase-negative Staphylococcus in a cancer centre linked to increased linezolid utilization. J Antimicrob Chemother 2010; 65:2001–4. 8. Bonilla H, Huband MD, Seidel J, et al. Multicity outbreak of linezolid-resistant Staphylococcus epidermidis associated with clonal spread of a cfr-containing gene. Clin Infect Dis 2010; 51:796–800. 9. Treviño M, Martinez-Lamas L, RomeroJung PA, Giráldez JM, Alvarez-Escudero J, Regueiro BJ. Endemic linezolid-resistant Staphylococcus epidermidis in a critical care unit. Eur J Clin Microbiol Infect Dis 2009; 28:527–33. 10. Kutscha-Lissberg F, Hebler U, Muhr G, Köller M. Linezolid penetration into bone and joint tissues infected with methicillinresistant staphylococci. Antimicrob Agents Chemother 2003; 47:3964–6. References 1. Gales AC, Sader HS, Andrade SS, Lutz L, Machado A, Barth AL. Emergence of linezolid-resistant Staphylococcus aureus during treatment of pulmonary infection in a patient with cystic fibrosis. Int J Antimicrob Agents 2006; 27:300–2. 2. Kola A, Kirschner P, Gohrbandt B, et al. An infection with linezolid-resistant S. aureus in Correspondence: Russell J. Benefield, PharmD, Department of Pharmacy, University of Utah Hospital, 50 N Medical Dr, A-050, Salt Lake City, UT 84132 ([email protected]). Clinical Infectious Diseases 2012;54(8):1216–7 Ó The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@ oup.com. DOI: 10.1093/cid/cis018 CORRESPONDENCE d CID 2012:54 (15 April) d 1217