No Outbreak of Vancomycin and Linezolid Resistance in Staphylococcal Pneumonia over a 10-Year Period

PLOS ONE, Dec 2019

Background Staphylococci can cause wound infections and community- and nosocomial-acquired pneumonia, among a range of illnesses. Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) have been rapidly increasing as a cause of infections worldwide in recent decades. Numerous reports indicate that S. aureus and MRSA are becoming resistant to many antibiotics, which makes them very dangerous. Therefore, this study retrospectively investigated the resistance to antimicrobial agents in all hospitalized patients suffering from community- or nosocomial-acquired pneumonia due to S. aureus and MRSA. Methods Information from the study groups suffering from either community- or nosocomial-acquired pneumonia caused by S. aureus or MRSA was gathered by searching records from 2004 to 2014 at the HELIOS Clinic Wuppertal, Witten/Herdecke University, Germany. The findings of antibiotic resistance were analyzed after the evaluation of susceptibility testing for S. aureus and MRSA. Results Total of 147 patients (63.9%, 95% CI 57.5%–69.8%), mean age 67.9 ± 18.5 years, with pneumonia triggered by S. aureus, and 83 patients (36.1%, 95% CI 30.2%–42.5%), mean age 72.3 ± 13.8 years, with pneumonia due to MRSA. S. aureus and MRSA developed no resistance to vancomycin (P = 0.019 vs. < 0.0001, respectively) or linezolid (P = 0.342 vs. < 0.0001, respectively). MRSA (95.3%) and S. aureus (56.3%) showed a high resistance to penicillin. MRSA (87.7%) was also found to have a high antibiotic resistance against ß-lactam antibiotics, compared to S. aureus (9.6%). Furthermore, MRSA compared to S. aureus, respectively, had increased antibiotic resistance to ciprofloxacin (90.1% vs. 17.0%), cefazolin (89.7% vs. 10.2%), cefuroxime (89.0% vs. 9.1%), levofloxacin (88.2% vs. 18.4%), clindamycin (78.0% vs. 14.7%), and erythromycin (76.5% vs. 20.8%). Conclusion No development of resistance was found to vancomycin and linezolid in patients with pneumonia caused by S. aureus and MRSA.

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No Outbreak of Vancomycin and Linezolid Resistance in Staphylococcal Pneumonia over a 10-Year Period

September No Outbreak of Vancomycin and Linezolid Resistance in Staphylococcal Pneumonia over a 10-Year Period Josef Yayan 0 1 2 Beniam Ghebremedhin 0 1 2 Kurt Rasche 0 1 2 Data Availability Statement: All relevant data are within the paper. 0 1 2 0 Abbreviations: ANOVA, analysis of variance; CLSI, Clinical and Laboratory Standards Institute; CRP , C- reactive protein; CI, confidence interval; EUCAST , European Committee on Antimicrobial Susceptibility Testing; ICD, International Classification of Diseases 1 Editor: Mark A Webber, University of Birmingham , UNITED KINGDOM 2 1 Witten/Herdecke University , Witten , Department of Internal Medicine, Division of Pulmonary, Allergy and Sleep Medicine, HELIOS Clinic Wuppertal, Germany, 2 Institute of Medical Laboratory Diagnostics, Center for Clinical and Translational Research, HELIOS Clinic Wuppertal , Germany Staphylococci can cause wound infections and community- and nosocomial-acquired pneumonia, among a range of illnesses. Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) have been rapidly increasing as a cause of infections worldwide in recent decades. Numerous reports indicate that S. aureus and MRSA are becoming resistant to many antibiotics, which makes them very dangerous. Therefore, this study retrospectively investigated the resistance to antimicrobial agents in all hospitalized patients suffering from community- or nosocomial-acquired pneumonia due to S. aureus and MRSA. - Background OPEN ACCESS MIC, minimum inhibitory concentration; MRSA, methicillin-resistant Staphylococcus aureus. Conclusion No development of resistance was found to vancomycin and linezolid in patients with pneumonia caused by S. aureus and MRSA. Introduction Material and Methods Ethics statement Setting Definition of pneumonia Clinical specimens Blood cultures Tested antibiotics Antimicrobial EUCAST Sensitive / Resistant > (mg/L) Sensitive / Resistant > (mg/L) CLSI Laboratory tests Comorbidities Statistical analysis S. aureus (n = 147) (%) 67.9 ± 18.5 MRSA (n = 83) (%) 72.3 ± 13.8 Odds ratio (95% CI %), P value 98.5 ± 113.7 12,217.2 ± 6,494.3 76.1 ± 80.1 12,179.3 ± 6,242.6 89 (60.5) 58 (39.5) 67 (45.6) 58 (39.5) 22 (15.0) 57 (68.7) 26 (31.3) 32 (38.6) 35 (42.2) 16 (19.3) 0.7 (0.4–1.2), 0.220 0.7 (0.4–1.2), 0.220 1.3 (0.8–2.3), 0.302 0.9 (0.5–1.5), 0.687 0.7 (0.4–1.5), 0.399 0.5 (0.3–0.8), 0.01 2.4 (1.2–4.7), 0.011 4.6 (1.0–20.6), 0.046 0.9 (0.4–2.1), 0.749 1.7 (0.2–16.7), 0.645 0.2 (0.02–1.8), 0.144 0.1 (0–2.3), 0.157 0.4 (0.2–0.8), 0.004 0.632 Discussion 3 S – – – – – A (0 ,) 1 (0 , 1 (0 ,) 1 (0 ,) 1 (0 , 1 SRM .0010 .0030 .0000< .0008 .)001 .0000< .0020 .0040 .0000< .0020 .0040 .0000< .0090 .)020 .0000< 0 0 0 0 0 – – – – 8 (0 , 1 (0 , 1 (0 , 1 (0 , 1 ) 0 ) 0 ) 0 ) 0 –(0 .34 8 1 0 7 1 0 7 1 0 5 1 0 0 00 .0 .0 000 .00 .00 00 .0 .0 00 .0 .0 0 0 0 0 0 0 0 0 0 . < . < . < . < 0 .0 0 0 0 0 .3 ,)7 –(00 .,)0020 .00001< –.(000080 .,)001 .00001< –.(20000 .,)003 .00010< –..(00102 .,.)01510 –.(20000 .,)003 .00010< –..(02001 ,..)014294 )iteund n A S R 0 1 0 0 0 0 0 0 0 0 1 3 4 3 3 5 4 0 4 4 4 4 1 1 1 1 1 1 0 0 0 0 7 6 7 2 4 6 1 0 – – 7 7 – , 2 , 1 8 – 6 – , .3 05 .)1 93 .00 .)4 07 .00 .02 07 04 .00 .9 02 .)0 59 0 .0 3 .4 ( 0 .9 ( , .0 .0 , 0 .0 6 .9 (0 1 0 .8 4 0 .2 .)0 0 (0 .)2 (0 4 0 0 0 4 1 –0 .50 .4 )1 88 .9 .0 –0 .50 ( 0 . 0 0 ( , ( ( , , .30 .)7 .8 641 .01 .8 .)4 .40 .)2 5 7 4 4 0 1 2 1 . io e I,i)(t59aoC%P .rseauuS –.,..)(90442120 –.,..)(430337010 –.,..)(80874230 –.,..)(00820320 –.,..)(240324010 –.,..)(040311100 –.,..)(040308100 –.,..)(780577200 –.,..)(050384200 –.,..)(4307101200 –.,..)(9903407310 –.0029.,.)(80100 –.,..)(930478600 –.,..)(20176670 –.,..)(120304430 r s 10/20 A SR 59 3 2 0 14 1 0 0 0 0 0 0 1 0 6 0 0 0 M t s n u ta e P is ru 17 4 7 1 8 2 0 0 0 0 0 0 0 0 2 0 0 1 t s a n e . R S S. aureus (n = 147) (%) MRSA (n = 83) (%) Odds ratio (95% CI, P value compared S. aureus and MRSA patients Cardiovascular disease 21 (14.3) 49 (33.3) 34 (23.1) 37 (25.2) 17 (11.6) 16 (10.9) 17 (11.6) 37 (25.2) 15 (10.2) 25 (17.0) 15 (10.2) 22 (15.0) 20 (13.6) 15 (10.2) 22 (15.0) 14 (16.9) 21 (25.3) 13 (15.7) 13 (15.7) 14 (16.9) 16 (19.3) 13 (15.7) 9 (10.8) 22 (26.5) 0.8 (0.4–1.6), 0.567 25 (30.1) 0.8 (0.4–1.4), 0.417 1.1 (0.5–2.5), 0.868 1.9 (0.7–5.4), 0.226 2.5 (0.8–8.0), 0.098 0.7 (0.4–1.3), 0.277 0.7 (03–1.8), 0.499 0.7 (03–1.5), 0.367 0.8 (0.4–1.7), 0.601 1.5 (0.8–2.7), 0.205 0.8 (0.4–1.6), 0.598 0.3 (0.2–0.5), < 0.0001 1.3 (0.5–3.2), 0.550 0.9 (0.4–2.1), 0.749 0.4 (0.2–0.8), 0.006 1.1 (0.6–2.1), 0.699 3.0 (0.9–10.8), 0.087 1.1 (0.5–2.3), 0.792 0.6 (0.3–1.4), 0.227 0.7 (0.4–1.5), 0.399 2.5 (0.9–6.8), 0.084 0.6 (0.3–1.2), 0.148 0.7 (0.4–1.5), 0.399 0.2 (0.1–0.6), 0.004 1.4 (0.6–3.1), 0.458 Abbreviations: MRSA: methicillin-resistant Staphylococcus aureus. Note: Statistically significant P values are shown in bold. 12 / 20 13 / 20 14 / 20 15 / 20 Study limitations pneumonia. Conclusions References 16 / 20 17 / 20 18 / 20 19 / 20 1 1. Ryu S , Son (...truncated)


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Josef Yayan, Beniam Ghebremedhin, Kurt Rasche. No Outbreak of Vancomycin and Linezolid Resistance in Staphylococcal Pneumonia over a 10-Year Period, PLOS ONE, 2015, 9, DOI: 10.1371/journal.pone.0138895