Background

The emergence and spread of linezolid and combined linezolid/vancomycin resistance in Enterococcus faecium (LVRE) is a major therapeutic challenge. Due to the unavailability of standardized selective culture media for LVRE screening, the detection of LVRE is laborious and costly. Systematic data on LVRE prevalence are scarce, and therefore, supportive evidence for the correct implementation of preemptive strategies is lacking.

Objective

We investigated the prevalence of LVRE in a vancomycin-resistant enterococci (VRE) endemic area in Germany in admission screening of high-risk patients for multidrug-resistant organisms to assess the necessity of LVRE screening.

Methods

We performed phenotypic testing for linezolid susceptibility in all patients (n = 2572) admitted to our hospital in the months of January, April, July and October 2018 with a positive VRE culture in their rectal admission screening swab. Eight isolates from seven patients with LVRE colonization were characterized by whole genome sequencing.

Results

Twenty-eight percent (712/2572) of screened patients were colonized by VRE. Seventy percent (497/712) of the isolates were available for testing and whole genome sequencing. A total of 1.4% (7/497) of VRE were LVRE, predominantly due to mutations of 23S rRNA. optrA, poxtA or cfr genes were not detected. Patients with LVRE colonization did not develop LVRE infections during their stay.

Conclusion

LVRE prevalence was low, and there was no evidence for the dissemination of linezolid resistance genes. Due to the low prevalence and the low risk of infection due to endogenous LVRE, we do not see the immediate necessity to introduce routine LVRE screening in our hospital.

中文翻译：

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在德国的一个流行地区，入院筛查时对利奈唑胺和万古霉素耐药的粪肠球菌联合用药的患病率较低。

背景

粪肠球菌（LVRE）中利奈唑胺和利奈唑胺/万古霉素联合耐药性的出现和扩散是主要的治疗挑战。由于无法使用标准的选择性培养基进行LVRE筛查，因此检测LVRE既费力又费钱。LVRE患病率的系统性数据很少，因此缺乏正确实施先发制人策略的支持证据。

目的

我们在德国万古霉素耐药肠球菌（VRE）流行地区调查了LVRE的患病率，评估了多药耐药生物的高危患者的入院筛查，以评估LVRE筛查的必要性。

方法

我们对2018年1月，4月，7月和10月入院的所有患者（n = 2572）的利奈唑胺敏感性进行了表型测试，其直肠入院筛查拭子中的VRE培养呈阳性。通过全基因组测序对来自7例LVRE定植患者的8个分离株进行了表征。

结果

VRE定殖了28％（712/2572）的筛查患者。分离株的百分之七十（497/712）可用于测试和全基因组测序。总计1.4％（7/497）的VRE为LVRE，主要是由于23S rRNA突变所致。未检测到optrA，poxtA或cfr基因。LVRE定植的患者在住院期间未发生LVRE感染。

结论

LVRE患病率低，并且没有证据显示利奈唑胺耐药基因的传播。由于内源性LVRE的低患病率和低感染风险，我们认为在我们的医院没有立即进行常规LVRE筛查的必要性。