Incidence, management and outcomes of the first cfr-mediated linezolid-resistant Staphylococcus epidermidis outbreak in a tertiary referral centre in the Republic of Ireland. Issue 4 (August 2015)

• Record Type: Journal Article
• Authors: O'Connor, C.; Powell, J.; Finnegan, C.; O'Gorman, A.; Barrett, S.; Hopkins, K.L.; Pichon, B.; Hill, R.; Power, L.; Woodford, N.; Coffey, J.C.; Kearns, A.; O'Connell, N.H.; Dunne, C.P.
• Is Part Of: Journal of hospital infection. Volume 90:Issue 4(2015)
• Page Start: 316
• Page End: 321
• Publication Date: 2015-08
• Subjects: Cross infection -- Periodicals; Cross infection -- Prevention -- Periodicals; Nosocomial infections -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Cross Infection -- Periodicals; Cross Infection -- prevention & control -- Periodicals; Infection Control -- Periodicals; Electronic journals; 614.44
• DOI: 10.1016/j.jhin.2014.12.013
• Languages: English
• ISSNs: 0195-6701

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Summary</title> <sec> <title id="sectitle0015">Aim</title> <p id="abspara0010">To report the first Irish outbreak of <italic>cfr</italic>-mediated linezolid-resistant <italic>Staphylococcus epidermidis</italic>.</p> </sec> <sec> <title id="sectitle0020">Methods</title> <p id="abspara0015">Linezolid-resistant <italic>S. epidermidis</italic> 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<italic>mec</italic>) 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.</p> </sec> <sec> <title id="sectitle0025">Findings</title> <p id="abspara0020">PFGE showed that all nine isolates represented a single clonal strain. MLST showed that they belonged to ST2, and SCC<italic>mec</italic> typing showed that they encoded a variant of SCC<italic>mec</italic>III. All nine isolates were <italic>cfr</italic> 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.</p> </sec> <sec> <title id="sectitle0030">Conclusions</title> <p id="abspara0025">This is the first documented outbreak of <italic>cfr</italic>-mediated linezolid-resistant <italic>S. epidermidis</italic> 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.</p> </sec> </abstract>