Characterization of coagulase-negative staphylococcal isolates from blood with reduced susceptibility to glycopeptides and therapeutic options

Coagulase-negative staphylococci (CoNS) are a major cause of nosocomial blood stream infection, especially in critically ill and haematology patients. CoNS are usually multidrug-resistant and glycopeptide antibiotics have been to date considered the drugs of choice for treatment. The aim of this stu...

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Published in:	BMC infectious diseases Vol. 9; no. 83; p. 83
Main Authors:	Natoli, Silvia, Fontana, Carla, Favaro, Marco, Bergamini, Alberto, Testore, Gian Piero, Minelli, Silvia, Bossa, Maria Cristina, Casapulla, Mauro, Broglio, Giorgia, Beltrame, Angela, Cudillo, Laura, Cerretti, Raffaella, Leonardis, Francesca
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 04-06-2009 BioMed Central BMC
Subjects:	Adult Aged Aged, 80 and over Amplified Fragment Length Polymorphism Analysis Anti-Bacterial Agents - therapeutic use Antibiotics Bacterial Typing Techniques Drug Resistance, Multiple, Bacterial - genetics Drug therapy Glycopeptides - therapeutic use Health aspects Humans Middle Aged Properties Staphylococcal infections Staphylococcal Infections - blood Staphylococcal Infections - drug therapy Staphylococcus Staphylococcus epidermidis - classification Staphylococcus epidermidis - drug effects Staphylococcus epidermidis - genetics Staphylococcus haemolyticus - classification Staphylococcus haemolyticus - drug effects Staphylococcus haemolyticus - genetics Italy
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Summary:	Coagulase-negative staphylococci (CoNS) are a major cause of nosocomial blood stream infection, especially in critically ill and haematology patients. CoNS are usually multidrug-resistant and glycopeptide antibiotics have been to date considered the drugs of choice for treatment. The aim of this study was to characterize CoNS with reduced susceptibility to glycopeptides causing blood stream infection (BSI) in critically ill and haematology patients at the University Hospital Tor Vergata, Rome, Italy, in 2007. Hospital microbiology records for transplant haematology and ICU were reviewed to identify CoNS with elevated MICs for glycopeptides, and isolates were matched to clinical records to determine whether the isolates caused a BSI. The isolates were tested for susceptibility to new drugs daptomicin and tigecycline and the genetic relationship was assessed using f-AFLP. Of a total of 17,418 blood cultures, 1,609 were positive for CoNS and of these, 87 (5.4%) displayed reduced susceptibility to glycopeptides. Clinical review revealed that in 13 cases (7 in haematology and 6 in ICU), CoNS with reduced susceptibility to glycopeptides were responsible for a BSI. Staphylococcus epidermidis was the causative organism in 11 instances and Staphylococcus haemolyticus in 2. The incidence of oxacillin resistance was high (77%), although all isolates remained susceptible to linezolid, daptomycin and tigecycline. Fingerprinting of CoNS identified one clonal relationship between two isolates. Multi-resistant CoNS with reduced susceptibility to glycopeptides, although still relatively infrequent in our hospital, are emerging pathogens of clinical concern. Surveillance by antibiotyping with attention to multi-resistant profile, and warning to clinicians, is necessary.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1471-2334 1471-2334
DOI:	10.1186/1471-2334-9-83