The emerging problem of linezolid-resistant Staphylococcus

J Antimicrob Chemother. 2013 Jan;68(1):4-11. doi: 10.1093/jac/dks354. Epub 2012 Sep 4.

Abstract

The oxazolidinone antibiotic linezolid has demonstrated potent antimicrobial activity against Gram-positive bacterial pathogens, including methicillin-resistant staphylococci. This article systematically reviews the published literature for reports of linezolid-resistant Staphylococcus (LRS) infections to identify epidemiological, microbiological and clinical features for these infections. Linezolid remains active against >98% of Staphylococcus, with resistance identified in 0.05% of Staphylococcus aureus and 1.4% of coagulase-negative Staphylococcus (CoNS). In all reported cases, patients were treated with linezolid prior to isolation of LRS, with mean times of 20.0 ± 47.0 months for S. aureus and 11.0 ± 8.0 days for CoNS. The most common mechanisms for linezolid resistance were mutation (G2576T) to the 23S rRNA (63.5% of LRSA and 60.2% of LRCoNS) or the presence of a transmissible cfr ribosomal methyltransferase (54.5% of LRSA and 15.9% of LRCoNS). The emergence of linezolid resistance in Staphylococcus poses significant challenges to the clinical treatment of infections caused by these organisms, and in particular CoNS.

Publication types

  • Review

MeSH terms

  • Acetamides / pharmacology*
  • Acetamides / therapeutic use*
  • Animals
  • Anti-Infective Agents / pharmacology
  • Anti-Infective Agents / therapeutic use
  • Drug Resistance, Bacterial / drug effects*
  • Drug Resistance, Bacterial / physiology
  • Humans
  • Linezolid
  • Oxazolidinones / pharmacology*
  • Oxazolidinones / therapeutic use*
  • Staphylococcal Infections / drug therapy*
  • Staphylococcal Infections / epidemiology
  • Staphylococcal Infections / physiopathology
  • Staphylococcus / drug effects*
  • Staphylococcus / pathogenicity

Substances

  • Acetamides
  • Anti-Infective Agents
  • Oxazolidinones
  • Linezolid