CHROMAgar™ LIN-R as an efficient screening tool to assess the prevalence of linezolid-resistant enterococci in German hospital patients—a multicentre study approach, 2021–2022

Author:

Bender Jennifer K1ORCID,Baufeld Elsa2,Becker Karsten2ORCID,Claus Heike3,Dudakova Anna4,Dörre Achim5,Fila Nikoletta6,Fleige Carola1,Hamprecht Axel7,Hoffmann Armin8,Hogardt Michael9,Kaasch Achim J1011,Kola Axel12,Kriebel Nancy1,Layer-Nicolaou Franziska1,Marschal Matthias6,Molitor Ernst13ORCID,Mutters Nico T14ORCID,Liese Jan6,Nelkenbrecher Claudia15,Neumann Bernd15ORCID,Rohde Holger8ORCID,Steinmann Jörg15,Sörensen Michael16,Thelen Philipp7,Weig Michael4,Zautner Andreas E1011,Werner Guido1

Affiliation:

1. Nosocomial Pathogens and Antibiotic Resistances Unit, Department of Infectious Diseases, National Reference Centre for Staphylococci and Enterococci, Robert Koch Institute , Wernigerode , Germany

2. Friedrich Loeffler Institute of Medical Microbiology, University Medicine Greifswald , Greifswald , Germany

3. Institute for Hygiene and Microbiology, University of Würzburg , Würzburg , Germany

4. Institute for Medical Microbiology and Virology, University Medical Center Göttingen , Göttingen , Germany

5. Department of Infectious Disease Epidemiology, Robert Koch Institute , Berlin , Germany

6. Institute of Medical Microbiology and Hygiene, University of Tübingen , Tübingen , Germany

7. Institute for Medical Microbiology and Virology, Carl von Ossietzky University Oldenburg and Klinikum Oldenburg , Oldenburg , Germany

8. Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf , Hamburg , Germany

9. Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe University Frankfurt , Frankfurt am Main , Germany

10. Faculty of Medicine, Institute of Medical Microbiology and Hospital Hygiene, Otto-von-Guericke-University , Magdeburg , Germany

11. Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke University Magdeburg , Magdeburg , Germany

12. Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Berlin , Germany

13. Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn , Bonn , Germany

14. Institute for Hygiene and Public Health, University Hospital Bonn , Bonn , Germany

15. Institute of Hospital Hygiene, Medical Microbiology and Infectious Diseases, Nuremberg General Hospital, Paracelsus Medical University , Nuremberg , Germany

16. Laboratory Prof. Gisela Enders and Colleagues , Stuttgart , Germany

Abstract

Abstract Background In recent years, an increasing number of linezolid-resistant enterococci (LRE) was recognized at the German National Reference Centre (NRC) for Enterococci. National guidelines on infection prevention recommend screening for LRE in epidemiologically linked hospital settings without referring to a reliable and rapid diagnostic method. Since 2020, CHROMAgar™ provide a chromogenic linezolid screening agar, LIN-R, suitable to simultaneously screen for linezolid-resistant staphylococci and enterococci. Objectives To assess the applicability of CHROMAgar™ LIN-R in clinical settings for detecting LRE directly from patient material and to infer prevalence rates of LRE amongst German hospital patients. Methods During the 3-month trial period, clinical samples were plated on CHROMAgar™ LIN-R. Antimicrobial susceptibility testing was performed using VITEK2 or disc diffusion. At the NRC, linezolid resistance was determined by broth microdilution, multiplex-PCR for cfr/optrA/poxtA and by a restriction-based assay for 23S rDNA mutations. Results The 12 participating study sites used 13 963 CHROMAgar™ LIN-R plates during the study period. Of 442 presumptive LRE, 192 were confirmed by phenotypic methods. Of these, 161 were received by the NRC and 121 (75%) were verified as LRE. Most of LR-E. faecium 53/81 (65%) exhibited a 23S rRNA gene mutation as the sole resistance-mediating mechanism, whereas optrA constituted the dominant resistance trait in LR-E. faecalis [39/40 (98%)]. Prevalence of LRE across sites was estimated as 1% (ranging 0.18%–3.7% between sites). Conclusions CHROMAgar™ LIN-R represents a simple and efficient LRE screening tool in hospital settings. A high proportion of false-positive results demands validation of linezolid resistance by a reference method.

Funder

Federal Ministry of Health, Germany

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Pharmacology (medical),Pharmacology,Microbiology (medical)

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