Buscar en
Enfermedades Infecciosas y Microbiología Clínica
Toda la web
Inicio Enfermedades Infecciosas y Microbiología Clínica Linezolid and vancomycin-resistant Enterococcus faecium peritonitis in a child a...
Información de la revista
Vol. 33. Núm. 1.
Páginas 66 (Enero 2015)
Descargar PDF
Más opciones de artículo
Vol. 33. Núm. 1.
Páginas 66 (Enero 2015)
Scientific letter
DOI: 10.1016/j.eimc.2014.05.008
Acceso a texto completo
Linezolid and vancomycin-resistant Enterococcus faecium peritonitis in a child after liver transplantation
Enterococcus faecium resistente a linezolid y vancomicina aislado en un niño con peritonitis sometido a trasplante hepático
Verónica García-Gila, María Rosa Gómez-Gila,
Autor para correspondencia

Corresponding author.
, Luis Escosa-Garcíab, Loreto Hierro-Llanilloc
a Department of Microbiology, Hospital La Paz, IdiPaz, Madrid, Spain
b Department of Pediatric Infection Disease, Hospital La Paz, IdiPaz, Madrid, Spain
c Service of Pediatric Hepatology and Transplantation, Hospital La Paz, IdiPaz, Madrid, Spain
Información del artículo
Texto completo
Descargar PDF
Texto completo

We report the first case of linezolid-resistant and vancomycin-resistant Enterococcus faecium (LRVREF) in a child in Spain.1–3 The patient was a 31 month-old boy who was admitted in our hospital in 2011, after a failed Kasai portoenteroanastomosis for biliary atresia. While awaiting a liver transplantation, he presented two episodes of fever with ascites, with negative blood cultures, both treated with vancomycin (10mg/kg every 6h) plus meropenem with resolution. Living-donor liver transplantation was performed in June 2012. Vancomycin plus meropenem was administered since liver transplantation as prophylaxis of perioperative infection. On the 10th postoperative (PO) day, he started with high fever and a neutrophil-rich fluid in abdominal drainages. Blood cultures rendered negative results. However in samples obtained from drainage a vancomycin-resistant E. faecium (VREF) was isolated. The isolate had also resistance to beta-lactams, levofloxacin and high resistance to aminoglycosides. Treatment was changed to linezolid (10mg/kg every 8h), plus amikacin and metronidazole. On the 4th PO week, after 22 days on linezolid, a LRVREF and Pseudomonas aeruginosa were isolated from the drainage. Treatment was changed to daptomycin (10mg/kg/day) plus fosfomycin (50mg/kg every 6h×8 days). Up to the resolution of bile leakage, by 52nd PO day, surveillance persisted in identifying the same two microorganisms. Daptomycin was stopped after a 33-days treatment, on PO day 67th. The patient was discharged without further complications up to the end of follow-up in December 2012. The VanA phenotype was confirmed by PCR.4 The presence of the most common linezolid resistance mutation, G2576T, was analyzed by pyrosequencing. The presence of a cfr gene was discarded by PCR. E. faecium was identified by MALDI-TOF (MALDI Biotyper, Bruker Daltonics) and the antibiotic susceptibility testing was performed using the Microscan® cards (SIEMENS). Minimal inhibitory concentration (MIC, μg/mL) values of the first isolate of VREF were: ampicillin >8, vancomycin >256, teicoplanin 24 and linezolid ≤1. In the isolates of LRVREF, MIC value of linezolid was 16μg/mL. MICs of linezolid, vancomycin and teicoplanin were confirmed by Etest® (Biomerieux) using the breakpoints recommended by the Clinical and Laboratory Standards Institute Guidelines (CLSI, 2012). The child was hospitalized in ICU where was another child with VREF culture from peritoneal fluid in the same period. As preventive measure, we carried out a colonization study to all patients in that ward and only one new patient was found to be colonized with VREF. Random Amplification of Polimorfic DNA (RAPD) patterns from the VREF isolates of the three patients were different, indicating a polyclonal spread of VREF. Multilocus sequence typing (MLST) was realized in the isolates of this patient. These belong to ST18 which in turn belong to clonal complex CC17, associated with nosocomial infections and outbreaks. The linezolid-resistant isolate from the case patient had the G2576T mutation in a 2:1 ratio of wild type to mutant alleles. This low mutation dosage might be related to the low MIC of this isolate. The safety and tolerability of linezolid favour its use in prolonged treatments, but it should be taken into account that continuous exposures during long periods increase the chance of selecting isolates with higher mutation dosages and higher linezolid MICs.5–8

M. Fossati, B. Cappelli, E. Biral, R. Chiesa, A. Biffi, C. Ossi, et al.
Fatal vancomycin- and linezolid-resistant Enterococcus faecium sepsis in a child undergoing allogeneic haematopoietic stem cell transplantation for beta-thalassaemia major.
J. Med. Microbiol., 59 (2010), pp. 839-842
I.A. Herrero, N.C. Issa, R. Patel.
Nosocomial spread of linezolid-resistant, vancomycin-resistant Enterococcus faecium.
N. Engl. J. Med., 346 (2002), pp. 867-869
R. Gómez-Gil, M.P. Romero-Gómez, A. García-Arias, M.G. Ubeda, M.S. Busselo, R. Cisterna, et al.
Nosocomial outbreak of linezolid-resistant Enterococcus faecalis infection in a tertiary care hospital.
Diagn Microbiol Infect Dis Elsevier Inc, 65 (2009), pp. 175-179
N. Woodford.
Glycopeptide-resistant enterococci: a decade of experience.
J. Med. Microbiol., 47 (1998), pp. 849-862
K.S. Long, B. Vester.
Resistance to linezolid caused by modifications at its binding site on the ribosome.
Antimicrob. Agents Chemother., 56 (2011), pp. 603-612
I. Quiles-Melero, R. Gómez-Gil, M.P. Romero-Gómez, A.M. Sánchez-Díaz, M. de Pablos, J. García-Rodriguez, et al.
Mechanisms of linezolid resistance among staphylococci in a tertiary hospital.
J. Clin. Microbiol., 51 (2013), pp. 998-1001
S.H. Marshall, C.J. Donskey, R. Hutton-Thomas, R.A. Salata, L.B. Rice.
Gene dosage and linezolid resistance in Enterococcus faecium and Enterococcus faecalis.
Antimicrob. Agents Chemother., 46 (2002), pp. 3334-3336
K.A. Ruggero, L.K. Schroeder, P.C. Schreckenberger, A.S. Mankin, J.P. Quinn.
Nosocomial superinfections due to linezolid-resistant Enterococcus faecalis: evidence for a gene dosage effect on linezolid MICs.
Diagn. Microbiol. Infect. Dis., 47 (2003), pp. 511-513
Copyright © 2014. Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica
Opciones de artículo
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos