TY - JOUR
T1 - Incidence, management and outcomes of the first cfr-mediated linezolid-resistant Staphylococcus epidermidis outbreak in a tertiary referral centre in the Republic of Ireland
AU - O'Connor, C.
AU - Powell, J.
AU - Finnegan, C.
AU - O'Gorman, A.
AU - Barrett, S.
AU - Hopkins, K. L.
AU - Pichon, B.
AU - Hill, R.
AU - Power, L.
AU - Woodford, N.
AU - Coffey, J. C.
AU - Kearns, A.
AU - O'Connell, N. H.
AU - Dunne, C. P.
N1 - Publisher Copyright:
© 2015 The Authors.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Aim: To report the first Irish outbreak of cfr-mediated linezolid-resistant Staphylococcus epidermidis. Methods: Linezolid-resistant S.epidermidis isolated at University Hospital Limerick from four blood cultures, one wound and four screening swabs (from nine patients) between April and June 2013 were characterized by pulsed-field gel electrophoresis (PFGE), multi-locus sequence typing (MLST) and staphylococcal cassette chromosome (SCC. mec) typing. Antibiotic susceptibilities were determined according to the guidelines of the British Society for Antimicrobial Chemotherapy. The outbreak was controlled through prohibiting prescription and use of linezolid, adherence to infection prevention and control practices, enhanced environmental cleaning, isolation of affected patients, and hospital-wide education programmes. Findings: PFGE showed that all nine isolates represented a single clonal strain. MLST showed that they belonged to ST2, and SCC. mec typing showed that they encoded a variant of SCC. mecIII. All nine isolates were cfr positive, and eight isolates were positive for the G2576T 23S rRNA mutation commonly associated with linezolid resistance. Isolates exhibited multiple antibiotic resistances (i.e. linezolid, gentamicin, methicillin, clindamycin, ciprofloxacin, fusidic acid and rifampicin). The adopted infection prevention intervention was effective, and the outbreak was limited to the affected intensive care unit. Conclusions: This is the first documented outbreak of cfr-mediated linezolid-resistant S.epidermidis in the Republic of Ireland. Despite this, and due to existing outbreak management protocols, the responsible micro-organism and source were identified efficiently. However, it became apparent that staff knowledge of antimicrobial susceptibilities and appropriate hygiene practices were suboptimal at the time of the outbreak, and that educational interventions (and re-inforcement) are necessary to avoid occurrence of antimicrobial resistance and outbreaks such as reported here.
AB - Aim: To report the first Irish outbreak of cfr-mediated linezolid-resistant Staphylococcus epidermidis. Methods: Linezolid-resistant S.epidermidis isolated at University Hospital Limerick from four blood cultures, one wound and four screening swabs (from nine patients) between April and June 2013 were characterized by pulsed-field gel electrophoresis (PFGE), multi-locus sequence typing (MLST) and staphylococcal cassette chromosome (SCC. mec) typing. Antibiotic susceptibilities were determined according to the guidelines of the British Society for Antimicrobial Chemotherapy. The outbreak was controlled through prohibiting prescription and use of linezolid, adherence to infection prevention and control practices, enhanced environmental cleaning, isolation of affected patients, and hospital-wide education programmes. Findings: PFGE showed that all nine isolates represented a single clonal strain. MLST showed that they belonged to ST2, and SCC. mec typing showed that they encoded a variant of SCC. mecIII. All nine isolates were cfr positive, and eight isolates were positive for the G2576T 23S rRNA mutation commonly associated with linezolid resistance. Isolates exhibited multiple antibiotic resistances (i.e. linezolid, gentamicin, methicillin, clindamycin, ciprofloxacin, fusidic acid and rifampicin). The adopted infection prevention intervention was effective, and the outbreak was limited to the affected intensive care unit. Conclusions: This is the first documented outbreak of cfr-mediated linezolid-resistant S.epidermidis in the Republic of Ireland. Despite this, and due to existing outbreak management protocols, the responsible micro-organism and source were identified efficiently. However, it became apparent that staff knowledge of antimicrobial susceptibilities and appropriate hygiene practices were suboptimal at the time of the outbreak, and that educational interventions (and re-inforcement) are necessary to avoid occurrence of antimicrobial resistance and outbreaks such as reported here.
KW - 23S rRNA methyltransferase
KW - First outbreak
KW - Ireland
KW - Multi-resistance
KW - Oxazolidinone resistance
KW - Plasmid-mediated
KW - Staphylococci
UR - http://www.scopus.com/inward/record.url?scp=84937634874&partnerID=8YFLogxK
U2 - 10.1016/j.jhin.2014.12.013
DO - 10.1016/j.jhin.2014.12.013
M3 - Article
C2 - 25648941
AN - SCOPUS:84937634874
SN - 0195-6701
VL - 90
SP - 316
EP - 321
JO - Journal of Hospital Infection
JF - Journal of Hospital Infection
IS - 4
ER -