Volume: 43 Issue: 3
Year: 2023, Page: 958-962, Doi: https://doi.org/10.51248/.v43i3.2721
Introduction and aim: The emergence of Multidrug-resistant Coagulase-negative Staphylococcus species is a therapeutic problem. Linezolid-resistant CoNS (LRCoNS) are on a significant rise, with a global prevalence of around 2%. The acquisition of cfr (chloramphenicol-florfenicol resistance) gene is the commonest mechanism leading to resistance. This study aimed to determine the molecular characterization of linezolid resistance in clinically significant isolates of Coagulase Negative Staphylococci (CoNS).
Material and Methods: The 1061 clinical isolates of CoNS were identified by standard bacteriological technique. Antibiotic sensitivity test was performed to determine the susceptibility to linezolid and those isolates with zone diameter ≤ 20 mm (linezolid screen positive) were further confirmed by the automated Vitek 2 compact system and MIC ≥ 8 μg/ml was resistant . The cfr gene was detected in phenotypically confirmed LRCoNS.
Results: Resistant to Linezolid was seen in 2.5% of clinically important isolates of Coagulase Negative Staphylococci. The resistance was maximum in S.hemolyticus (70%), followed by S.cohnii (22.2%). Among the LRCoNS, the overall cfr gene was detected in 78% of isolates, predominantly in S.hemolyticus and S. cohnii. All the LRCoNs were also MRCoNS (methicillin resistance). However, all isolates were susceptible to glycopeptides.
Conclusion: There has been a surge of CoNS being reported from clinical samples with resistance to many important antimicrobials, including linezolid. The presence of cfr gene is the most common mechanism of resistance to linezolid. Early and correct identification of these isolates and adherence to infection control protocols will help for better clinical outcomes
Keywords: Linezolid resistance; CoNS; cfr gene; molecular characterization
1. Mandell,G.L., Dougles, Bennett, J.E. Textbook of principle and practice of infectious disease. Churchill Livingstone Elsevier. 2010; 7th edition. 2579-2586.
2. Rogers, K.L., Fey, P. D., Rupp, M. E. Coagulase-negative Staphylococcal infections. infect Dis Clin North Am.2009; 23:73-98.
3. Winn, W. C., Koneman, E. W., Allen, S.D., Procop G, W., Ganda, W. M., Woods, G. L. Koneman’s ColorAtlas and textbook of Diagnostic Microbiology. Sixth edition. China: Lippincott Williams and Willkins; 2006.
4. Bhatt, P., Tandel, K., Singh, A., Mugunthan, M., Grover, N, Sahni, A.K. Species distribution and antimicrobial resistance pattern of coagulase-negative Staphylococci at a tertiary care centre. Med J Armed Forces India. 2016; 72:71-74.
5. Singhal, R., Dhawan, S., Mohanty, S., Sood, S., Kapil, A., Dhawan, B., et al., Species distribution and antimicrobial susceptibility of coagulase negative Staphylococci in a tertiary care hospital. Ind J Med Res. 2006; 123:569-70.
6. Vinh, D. C. Rubinstein, E. Linezolid: A review of safety and tolerability. Journal of Infection. 2009; 59: 59-74.
7. Leach, K. L., Swaney, S. M., Colca, J. R., McDonald, W.G., Blinn, J.R., Thomasco, L.M., et al., The site of action of oxazolidinone antibiotics in living bacteria and in human mitochondria. Molecular cell. 2007;26(3):393-402.
8. Rajan, V., Kumar, V. G., Gopal, S. A cfr-positive clinical Staphylococcal isolate from India with multiple mechanisms of linezolid-resistance. Indian J Med Res. 2014;139(3):463-467.
9. Rodríguez-Aranda, A., Daskalaki, M., Villar, J., Sanz, F., Otero, J. R., Chaves, F. Nosocomial spread of linezolid-resistant Staphylococcus haemolyticus infections in an intensive care unit. Diagn. Microbiol. Infect. Dis. 2009; 63: 398-402.
10. Long, K.S., Vester, B. Resistance to linezolid caused by modifications at its binding site on the ribosome. Antimicrobial Agents and Chemotherapy. 2012;56(2):603-612.
11. Gu, B., Kelesidis, T., Tsiodras, S., Hindler, J., Humphries, R.M. The emerging problem of linezolid-resistant Staphylococcus. J. Antimicrob. Chemother. 2013: 68; 4-11.
12. Rajkumar, S., Sistla, S., Manoharan, M., Sugumar, M., Nagasundaram, N., Parija, S.C., et al., Prevalence and genetic mechanisms of antimicrobial resistance in Staphylococcus
13. species: A multicentre report of the Indian Council of Medical Research antimicrobial resistance surveillance network. Indian J Med Microbiol. 2017;35(1):53-60.
14. Collee, J.G., Marmion, B.P., Fraser, A.G., Simmons, A. Laboratory strategy in the diagnosis of infective syndromes. In: Collee JG, Marmion BP, Fraser AG, Simmons A. (eds.) Mackie & McCartney Practical Medical Microbiology. 14th edition. London: Elsevier; 2007.p. 53-94.
15. Clinical and Laboratory Standards Institute (CLSI) (2018) Performance Standards for Antimicrobial Susceptibility Testing. CLSI Approved Standard M100-S15. Clinical and Laboratory Standards Institute, Wayne.
16. DNA extraction kit (Trueprep autoTM ) Molbio Diagnostics Pvt. Ltd.
17. Zhou, W., Niu, D., Gao, S., Zhong, Q., Liu, C., Liao, X., et al., Prevalence, biofilm formation, and mass spectrometric characterization of linezolid-resistant Staphylococcus capitis isolated from a tertiary hospital in China. J Glob Antimicrob Resist. 2023; 29;33:155-163.
18. Abdelwahab, M. A., Amer, W. H., Elsharawy, D., Elkolaly, R. M., Helal, R. A. E. F., El Malla, D. A., et al., Phenotypic and genotypic characterization of methicillin resistance in Staphylococci isolated from an Egyptian University hospital. Pathogens (Basel, Switzerland). 2023; 12(4): 556.
19. Shah, S., Rampal, R., Thakkar, P., Poojary, S., Ladi, S. The prevalence and antimicrobial susceptibility pattern of gram-positive pathogens: Three-year study at a tertiary care hospital in Mumbai, India. J Lab Physicians. 2021; 14(2): 109-114
20. Nepal, H.P., Acharya, A., Gautam, R., Shresta, S., Paudei, R. Bacteriological profile of neonatal septicemia cases and the antimicrobial resistance pattern in a tertiary care hospital of central Nepal. Int J Biomed Res. 2013; 4: 26-31.
21. Kalawat, U., Sharma, K.K., Reddy, S. Linezolidresistant Staphylococcus spp. at a tertiary care hospital of Andhra Pradesh. Indian J Med Microbiol. 2011; 29:314-315.
22. Gupta, V., Garg, S., Jain, R., Garg, S., Chander, J. Linezolid resistant Staphylococcus haemolyticus: first case report from India. Asian Pac J Trop Med. 2012; 5: 837-838.
23. Matlani, M., Shende, T., Bhandari, V., Dawar, R., Sardana, R., Gaind, R. Linezolid-resistant mucoid Staphylococcus haemolyticus from a tertiary-care centre in Delhi. New Microbes and New Infections. 2016; 11: 57-58.
24. Quiles-Melero, I., Gómez-Gil, R., Romero-Gómez, M. P., Sánchez-Díaz, A. M., de Pablos, M., García-Rodriguez, J., et al., Mechanisms of linezolid resistance among Staphylococci in a tertiary hospital. J Clin Microbiol. 2013;51(3): 998-1001.
25. Chamon, R.C., Iorio, N.L., Cavalcante, F.S., Teodoro,C.R., de Oliveira, A.P., Maia, F., et al., Linezolid-resistant Staphylococcus haemolyticus and Staphylococcus hominis: single and double mutations at the domain V of 23S rRNA among isolates from a Rio de Janeiro hospital. Diagnostic microbiology and infectious disease. 2014;80(4):307-310. 26. Manoharan, M., Sistla, S., Ray, P. Prevalence and molecular determinants of antimicrobial resistance in clinical isolates of Staphylococcus haemolyticus from India. Microbial Drug Resistance. 2021;27(4):501-508
Priya Chaudhary, Anita Pandey, Priyanka Chaturvedi, Km. Sangita. Molecular characterization of linezolid resistance in clinically significant isolates of coagulase negative Staphylococcus species, a hospital based study from Western Uttar Pradesh. Biomedicine: 2023; 43(3): 958-962