Combined antibiotic stewardship and infection control measures to contain the spread of linezolid-resistant Staphylococcus epidermidis in an intensive care unit

Antimicrobial Resistance & Infection Control

Cihan Papan¹  Fabian K. Berger¹  Sören L. Becker¹  Katharina Last¹  Barbara C. Gärtner¹  Frederic Albrecht²  Tobias Fink²  Matthias Schröder²  Heike Knoll²  Thomas Volk²  Jürgen Geisel³  Mathias Hoffmann⁴  Alexander Mellmann⁵ 

[1] Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, 66421, Homburg, Germany;Department of Anesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, Homburg, Germany;Department of Clinical Chemistry and Laboratory Medicine, Saarland University, Homburg, Germany;Hospital Pharmacy, Saarland University, Homburg, Germany;Institute of Hygiene, University Hospital Münster, Münster, Germany;

关键词: Antimicrobial stewardship;    Infection control;    Antimicrobial resistance;    Linezolid;    Staphylococci;    Whole-genome sequencing;   

DOI  :  10.1186/s13756-021-00970-3

来源: Springer

【 摘 要 】

BackgroundThe unrestricted use of linezolid has been linked to the emergence of linezolid-resistant Staphylococcus epidermidis (LRSE). We report the effects of combined antibiotic stewardship and infection control measures on the spread of LRSE in an intensive care unit (ICU).MethodsMicrobiological data were reviewed to identify all LRSE detected in clinical samples at an ICU in southwest Germany. Quantitative data on the use of antibiotics with Gram-positive coverage were obtained in defined daily doses (DDD) per 100 patient-days (PD). In addition to infection control measures, an antibiotic stewardship intervention was started in May 2019, focusing on linezolid restriction and promoting vancomycin, wherever needed. We compared data from the pre-intervention period (May 2018–April 2019) to the post-intervention period (May 2019–April 2020). Whole-genome sequencing (WGS) was performed to determine the genetic relatedness of LRSE isolates.ResultsIn the pre-intervention period, LRSE were isolated from 31 patients (17 in blood cultures). The average consumption of linezolid and daptomycin decreased from 7.5 DDD/100 PD and 12.3 DDD/100 PD per month in the pre-intervention period to 2.5 DDD/100 PD and 5.7 DDD/100 PD per month in the post-intervention period (p = 0.0022 and 0.0205), respectively. Conversely, vancomycin consumption increased from 0.2 DDD/100 PD per month to 4.7 DDD/100 PD per month (p < 0.0001). In the post-intervention period, LRSE were detected in 6 patients (4 in blood cultures) (p = 0.0065). WGS revealed the predominance of one single clone.ConclusionsComplementing infection control measures by targeted antibiotic stewardship interventions was beneficial in containing the spread of LRSE in an ICU.

【 授权许可】

CC BY