PMID- 28961986
OWN - NLM
STAT- MEDLINE
DCOM- 20180702
LR  - 20220318
IS  - 1460-2091 (Electronic)
IS  - 0305-7453 (Linking)
VI  - 72
IP  - 12
DP  - 2017 Dec 1
TI  - Novel multiresistance cfr plasmids in linezolid-resistant methicillin-resistant 
      Staphylococcus epidermidis and vancomycin-resistant Enterococcus faecium (VRE) 
      from a hospital outbreak: co-location of cfr and optrA in VRE.
PG  - 3252-3257
LID - 10.1093/jac/dkx292 [doi]
AB  - BACKGROUND: Linezolid is often the drug of last resort to treat infections caused 
      by Gram-positive cocci. Linezolid resistance can be mutational (23S rRNA or 
      L-protein) or, less commonly, acquired [predominantly cfr, conferring resistance 
      to phenicols, lincosamides, oxazolidinones, pleuromutilins and streptogramin A 
      compounds (PhLOPSA) or optrA, encoding oxazolidinone and phenicol resistance]. 
      OBJECTIVES: To investigate the clonality and genetic basis of linezolid 
      resistance in 13 linezolid-resistant (LZDR) methicillin-resistant Staphylococcus 
      epidermidis (MRSE) isolates recovered during a 2013/14 outbreak in an ICU in an 
      Irish hospital and an LZDR vancomycin-resistant Enterococcus faecium (VRE) 
      isolate from an LZDR-MRSE-positive patient. METHODS: All isolates underwent 
      PhLOPSA susceptibility testing, 23S rRNA sequencing, DNA microarray profiling and 
      WGS. RESULTS: All isolates exhibited the PhLOPSA phenotype. The VRE harboured cfr 
      and optrA on a novel 73 kb plasmid (pEF12-0805) also encoding erm(A), erm(B), 
      lnu(B), lnu(E), aphA3 and aadE. One MRSE (M13/0451, from the same patient as the 
      VRE) harboured cfr on a novel 8.5 kb plasmid (pSEM13-0451). The remaining 12 MRSE 
      lacked cfr but exhibited linezolid resistance-associated mutations and were 
      closely related to (1-52 SNPs) but distinct from M13/0451 (202-223 SNPs). 
      CONCLUSIONS: Using WGS, novel and distinct cfr and cfr/optrA plasmids were 
      identified in an MRSE and VRE isolate, respectively, as well as a cfr-negative 
      LZDR-MRSE ICU outbreak and a distinct cfr-positive LZDR-MRSE from the same ICU. 
      To our knowledge, this is the first report of cfr and optrA on a single VRE 
      plasmid. Ongoing surveillance of linezolid resistance is essential to maintain 
      its therapeutic efficacy.
CI  - (c) The Author 2017. Published by Oxford University Press on behalf of the British 
      Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, 
      please email: journals.permissions@oup.com.
FAU - Lazaris, Alexandros
AU  - Lazaris A
AD  - Microbiology Research Unit, Dublin Dental University Hospital, University of 
      Dublin, Trinity College Dublin, Dublin, Ireland.
FAU - Coleman, David C
AU  - Coleman DC
AD  - Microbiology Research Unit, Dublin Dental University Hospital, University of 
      Dublin, Trinity College Dublin, Dublin, Ireland.
FAU - Kearns, Angela M
AU  - Kearns AM
AD  - Antimicrobial Resistance and Healthcare Infections Reference Unit, National 
      Infection Service, Public Health England, London, UK.
FAU - Pichon, Bruno
AU  - Pichon B
AD  - Antimicrobial Resistance and Healthcare Infections Reference Unit, National 
      Infection Service, Public Health England, London, UK.
FAU - Kinnevey, Peter M
AU  - Kinnevey PM
AD  - Microbiology Research Unit, Dublin Dental University Hospital, University of 
      Dublin, Trinity College Dublin, Dublin, Ireland.
FAU - Earls, Megan R
AU  - Earls MR
AD  - Microbiology Research Unit, Dublin Dental University Hospital, University of 
      Dublin, Trinity College Dublin, Dublin, Ireland.
FAU - Boyle, Breida
AU  - Boyle B
AD  - Department of Clinical Microbiology, School of Medicine, Trinity College Dublin, 
      St James's Hospital, Dublin, Ireland.
FAU - O'Connell, Brian
AU  - O'Connell B
AD  - Department of Clinical Microbiology, School of Medicine, Trinity College Dublin, 
      St James's Hospital, Dublin, Ireland.
AD  - National MRSA Reference Laboratory, St James's Hospital, James's St, Dublin, 
      Ireland.
FAU - Brennan, Grainne I
AU  - Brennan GI
AD  - National MRSA Reference Laboratory, St James's Hospital, James's St, Dublin, 
      Ireland.
FAU - Shore, Anna C
AU  - Shore AC
AD  - Microbiology Research Unit, Dublin Dental University Hospital, University of 
      Dublin, Trinity College Dublin, Dublin, Ireland.
LA  - eng
PT  - Journal Article
PL  - England
TA  - J Antimicrob Chemother
JT  - The Journal of antimicrobial chemotherapy
JID - 7513617
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (RNA, Ribosomal, 23S)
RN  - ISQ9I6J12J (Linezolid)
SB  - IM
MH  - Anti-Bacterial Agents/*pharmacology
MH  - Cross Infection/*epidemiology
MH  - Disease Outbreaks
MH  - *Drug Resistance, Bacterial
MH  - Enterococcus faecium/*drug effects/genetics/isolation & purification
MH  - Genes, Bacterial
MH  - Hospitals
MH  - Humans
MH  - Ireland/epidemiology
MH  - Linezolid/*pharmacology
MH  - Microarray Analysis
MH  - Microbial Sensitivity Tests
MH  - Plasmids/*analysis
MH  - RNA, Ribosomal, 23S/genetics
MH  - Sequence Analysis, DNA
MH  - Staphylococcus epidermidis/*drug effects/genetics/isolation & purification
MH  - Vancomycin-Resistant Enterococci/drug effects/genetics/isolation & purification
MH  - Whole Genome Sequencing
EDAT- 2017/09/30 06:00
MHDA- 2018/07/03 06:00
CRDT- 2017/09/30 06:00
PHST- 2017/06/09 00:00 [received]
PHST- 2017/07/19 00:00 [accepted]
PHST- 2017/09/30 06:00 [pubmed]
PHST- 2018/07/03 06:00 [medline]
PHST- 2017/09/30 06:00 [entrez]
AID - 4096430 [pii]
AID - 10.1093/jac/dkx292 [doi]
PST - ppublish
SO  - J Antimicrob Chemother. 2017 Dec 1;72(12):3252-3257. doi: 10.1093/jac/dkx292.