@article{3021696,
    title = "Dissemination of linezolid-dependent, linezolid-resistant Staphylococcus epidermidis clinical isolates belonging to CC5 in German hospitals",
    author = "Layer, F. and Vourli, S. and Karavasilis, V. and Strommenger, B. and Dafopoulou, K. and Tsakris, A. and Werner, G. and Pournaras, S.",
    journal = "The Journal of antimicrobial chemotherapy",
    year = "2018",
    volume = "73",
    number = "5",
    pages = "1181-1184",
    publisher = "Oxford University Press",
    doi = "10.1093/jac/dkx524",
    keywords = "linezolid;  RNA 23S;  antiinfective agent;  bacterial protein;  linezolid;  RNA 23S, antibiotic resistance;  Article;  bacterial growth;  bacterium isolate;  broth dilution;  clone;  controlled study;  epsilometer test;  gene mutation;  Germany;  growth curve;  human;  minimum inhibitory concentration;  nonhuman;  polymerase chain reaction;  Staphylococcus epidermidis;  cross infection;  disease transmission;  DNA sequence;  drug effect;  genetics;  genotype;  growth, development and aging;  hospital;  isolation and purification;  metabolism;  microbial sensitivity test;  microbiology;  molecular epidemiology;  molecular typing;  Staphylococcus epidermidis;  Staphylococcus infection, Anti-Bacterial Agents;  Bacterial Proteins;  Cross Infection;  Disease Transmission, Infectious;  Genotype;  Germany;  Hospitals;  Humans;  Linezolid;  Microbial Sensitivity Tests;  Molecular Epidemiology;  Molecular Typing;  RNA, Ribosomal, 23S;  Sequence Analysis, DNA;  Staphylococcal Infections;  Staphylococcus epidermidis",
    abstract = "Objectives: Linezolid-resistant Staphylococcus epidermidis (LRSE) and linezolid-dependent ST22 strains have been shown to predominate in tertiary care facilities all over Greece.We report herein the dissemination of ST22 but also ST2, ST5 and ST168 linezolid-dependent LRSE clones in four unrelated German hospitals. Methods: Fourteen LRSE clinical isolates recovered during 2012-14 from five distantly located German hospitals were tested by for MIC determination broth microdilution and Etest, PCR/sequencing for cfr and for mutations in 23S rRNA, rplC, rplD and rplV genes, MLST, PFGE and growth curves without and with linezolid at 16 and 32mg/L. Results: Most (11, 78.6%) isolates had linezolid MICs .256 mg/L. Five isolates carried the cfr gene. Eight isolates belonged to ST22, two isolates each to ST168 and ST2 and one isolate each to ST5 and ST23. Ten isolates [seven belonging to ST22 and one to each of ST2, ST5 and ST168; all these STs belong to clonal complex (CC) 5] exhibited linezolid-dependent growth, growing significantly faster in linezolid-containing broth. Four isolates were non-dependent (one belonging to each of ST22, ST2, ST23 and ST168). Four isolates came from three different hospitals, whereas four and six isolates were recovered during outbreaks of LRSE in two distinct hospitals. Conclusions: The multi-clonal dissemination of CC5 linezolid-dependent LRSE throughout German hospitals along with the clonal expansion of ST22 linezolid-dependent LRSE in Greek hospitals is of particular concern. It is plausible that this characteristic is inherent and provides a selective advantage to CC5 LRSE under linezolid pressure, contributing to their dissemination throughout hospitals in these countries. © The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved."
}