Increasing Linezolid-resistant Enterococcus in a Children’s Hospital

Bagga, Bindiya; Buckingham, Steve; Arnold, Susan; Nesbitt, Amanda; Guimera, Don; Lee, Kelley

doi:10.1097/inf.0000000000001769

“…Such increase has already been reported by other teams. For example, Buccelatto et al reported on a 3-fold increase in linezolid prescriptions from 2004 to 2011 in hospitalized children [ 10 ] while Bagga et al described a 5-fold increase in linezolid use between 2007 and 2014 in an American children’s hospital [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the literature we observe a constant and rapid increase of the articles reporting its use in neonates. Moreover some NICUs have reported on the increasing use of this antibiotic at the local scale [ 10 , 11 ]. Such an increase has also been observed in our NICU setting in Lyon, France over the past decade.…”

Section: Introductionmentioning

confidence: 99%

Increasing use of linezolid in a tertiary NICU during a 10-year period: reasons and concerns for the future

Matrat

¹

,

Plaisant

²

,

Barreto

³

et al. 2020

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

Background Linezolid has been increasingly used in tertiary NICUs. The objectives of this study were to explore the indications of these linezolid prescriptions, to analyze a possible misuse and to provide solutions to avoid such misuse. Methods A monocentric retrospective cohort study included all neonates hospitalized in one tertiary NICU between January 1st, 2010 and December 31st, 2019 and who received at least one administration of linezolid. These data were confronted to epidemiological and antibiotic use data from the same NICU. Two independent pediatricians secondarily classified linezolid uses as adequate or not. Results During the study period, 66 infections in 57 patients led to linezolid use. Most patients were pre-term and 21 patients (37%) died. Infections were mainly related to methicillin-resistant coagulase negative staphylococci and were frequently either pneumoniae (35%) or isolated bacteremia (48%), including 25 persistent bacteremia (64% of the 39 bacteremia). Need for a better tissue distribution or first-line treatment failure were the main reasons to initiate linezolid. Linezolid was administered for a median duration of 7 [3;10] days. No side effects were reported. Twenty-two (33%) of the 66 linezolid prescriptions were retrospectively classified as inadequate. Conclusions A rapid increase in linezolid prescriptions has been observed in our tertiary NICU, from 2014 to 2019, with 33% inadequate uses. This worrisome trend should lead to search for therapeutic alternatives and to work on antibiotic stewardship to prevent the emergence of new antimicrobial bacterial resistance.

show abstract

“…Such increase has already been reported by other teams. For example, Buccelatto et al reported on a 3-fold increase in linezolid prescriptions from 2004 to 2011 in hospitalized children (10) while Bagga et al described a 5-fold increase in linezolid use between 2007 and 2014 in an American children's hospital (11).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover some NICUs have reported on the increasing use of this antibiotic at the local scale (10,11).…”

Section: Introductionmentioning

confidence: 99%

Increasing use of linezolid in a tertiary NICU during a 10-year period: reasons and concerns for the future

Matrat

¹

,

Plaisant

²

,

Barreto

³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Linezolid has been increasingly used in tertiary NICUs. The objectives of this study were to explore the indications of these linezolid prescriptions, to analyze a possible misuse and to provide solutions to avoid such misuse. Methods A monocentric retrospective cohort study included all neonates hospitalized in one tertiary NICU between January 1st, 2010 and December 31st, 2019 and who received at least one administration of linezolid. These data were confronted to epidemiological and antibiotic use data from the same NICU. Two independent pediatricians secondarily classified linezolid uses as adequate or not. Results During the study period, 66 infections in 57 patients led to linezolid use. Most patients were pre-term and 21 patients (37%) died. Infections were mainly related to methicillin-resistant coagulase negative staphylococci and were frequently either pneumoniae (35%) or isolated bacteremia (48%), including 25 persistent bacteremia (64% of the 39 bacteremia). Need for a better tissue distribution or first-line treatment failure were the main reasons to initiate linezolid. Linezolid was administered for a median duration of 7 [3;10] days. No side effects were reported. Twenty-two (33%) of the 66 linezolid prescriptions were retrospectively classified as inadequate. Conclusions A rapid increase in linezolid prescriptions has been observed in our tertiary NICU, from 2014 to 2019, with 33% inadequate uses. This worrisome trend should lead to search for therapeutic alternatives and to work on antibiotic stewardship to prevent the emergence of new antimicrobial bacterial resistance.

show abstract

“…8 Widespread use anti-VRE coverage may also increase healthcare costs and promote resistance. 9 However, failure to cover VRE at the onset may result in rapid worsening of an infection and may increase both the required treatment duration with these agents 10 and the risk of adverse events. The choice to add empiric VRE coverage entails a careful balancing of the harms and benefits of a therapy.…”

mentioning

confidence: 99%

Using VRE screening tests to predict vancomycin resistance in enterococcal bacteremia

Butler‐Laporte

¹

,

Cheng

²

,

McDonald

³

et al. 2020

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Background and objective:Enterococcus causes clinically significant bloodstream infections (BSIs). In centers with a higher prevalence of vancomycin resistant enterococcus (VRE) colonization, a common clinical question is whether empiric treatment directed against VRE should be initiated in the setting of a suspected enterococcal BSI. Unfortunately, VRE treatment options are limited, and relatively expensive, and subject patients to the risk of adverse reactions. We hypothesized that the results of VRE colonization screening could predict vancomycin resistance in enterococcal BSI.Methods:We reviewed 370 consecutive cases of enterococcal BSI over a 7-year period at 2 tertiary-care hospitals to determine whether vancomycin-resistant BSIs could be predicted based on known colonization status (ie, patients with swabs performed within 30 days, more remotely, or never tested). We calculated sensitivity and specificity, and we plotted negative predictives values (NPVs) and positive predictive values (PPVs) as a function of prevalence.Results:A negative screening swab within 30 days of infection yielded NPVs of 90% and 95% in settings where <27.0% and 15.0% of enterococcal BSI are resistant to vancomycin, respectively. In patients with known VRE colonization, the PPV for VRE in enterococcal BSI was >50% at any prevalence exceeding 25%.Conclusions:The results of a negative VRE screening test result performed within 30 days can help eliminate unnecessary empiric therapy in patients with suspected enterococcal BSI. Conversely, patients with positive VRE screening swabs require careful consideration of empiric VRE-directed therapy when enterococcal BSI appears likely.

show abstract

Increasing Linezolid-resistant Enterococcus in a Children’s Hospital

Cited by 11 publications

References 10 publications

Increasing use of linezolid in a tertiary NICU during a 10-year period: reasons and concerns for the future

Increasing use of linezolid in a tertiary NICU during a 10-year period: reasons and concerns for the future

Increasing use of linezolid in a tertiary NICU during a 10-year period: reasons and concerns for the future

Using VRE screening tests to predict vancomycin resistance in enterococcal bacteremia

Contact Info

Product

Resources

About