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ORIGINAL RESEARCH article
Front. Microbiol.
Sec. Antimicrobials, Resistance and Chemotherapy
Volume 15 - 2024 |
doi: 10.3389/fmicb.2024.1455945
This article is part of the Research Topic Opportunistic pathogens: pathogenesis and multi-drug resistance mechanisms View all 4 articles
Investigation of a linezolid-resistant Staphylococcus epidermidis outbreak in a French hospital: phenotypic, genotypic, and clinical characterization
Provisionally accepted- 1 Centre Hospitalier Universitaire de Tours, Tours, France
- 2 Université de Tours, Tours, France
We aimed to retrospectively investigate an outbreak of linezolid-resistant Staphylococcus epidermidis (LRSE), at Tours University Hospital between 2017 and 2021.Methods: Twenty of the 34 LRSE isolates were included in the study. Antimicrobial susceptibility testing was performed using the disk diffusion method and MICs of last-resort antibiotics were determined using broth microdilution or Etest. Seventeen of the 20 resistant strains were sent to the French National Reference Centre for Staphylococci to determine the mechanism of resistance to linezolid. The clonal relationship between LRSE strains was assessed by PFGE and the sequence type determined by MLST. We retrospectively evaluated a new typing tool, IR-biotyper, and compared its results to PFGE to evaluate its relevance for S. epidermidis typing. Medical records were reviewed, and antibiotic consumption was determined. Search for a cross transmission was performed. Results: All LRSE strains showed high levels of resistance to linezolid (MICs ≥ 256 mg/L) and were multi-drug resistant. Linezolid resistance was associated with the 23S rRNA G2576T mutation and none of the 17 strains analyzed carried the cfr gene. Ninety-five percent of the 20 LRSE studied strains were genetically related and belonged to sequence-type ST2. The dendrogram obtained from IR-Biotyper showed 87% congruence with the PFGE analysis. Prior to isolation of the LRSE strain, 70% of patients received linezolid. No patients stayed successively in the same room.Linezolid exposure may promote the survival and spread of LRSE strains. At Tours University Hospital, acquisition of the resistant clone may also have been triggered by hand-to-hand transmission by healthcare workers. In addition, IR-biotyper is a promising typing tool for the study of clonal outbreaks due to its low cost and short turnaround time, although further studies are needed to assess the optimal analytical parameters for routine use.
Keywords: Staphylococcus epidermidis, linezolid, multi-drug resistance, genotyping, sequence type ST2, IR-Biotyper
Received: 27 Jun 2024; Accepted: 19 Aug 2024.
Copyright: © 2024 Lépine, Bras-Cachinho, Couratin, LEMAIRE, Chaufour, Junchat and Lartigue. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Nadège Lépine, Centre Hospitalier Universitaire de Tours, Tours, France
Marie-Frédérique Lartigue, Centre Hospitalier Universitaire de Tours, Tours, France
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José Bras-Cachinho
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