Journal Article

Varying linezolid susceptibility of vancomycin-resistant <i>Enterococcus faecium</i> isolates during therapy: a case report

Stefanie Swoboda, Stefan Fritz, Marcus E. Martignoni, Rita A. Feldhues, Torsten Hoppe-Tichy, Markus W. Buchler and Heinrich K. Geiss

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 56, issue 4, pages 787-789
Published in print October 2005 | ISSN: 0305-7453
Published online September 2005 | e-ISSN: 1460-2091 | DOI:
Varying linezolid susceptibility of vancomycin-resistant Enterococcus faecium isolates during therapy: a case report

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  • Medical Oncology
  • Critical Care


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Objectives: Linezolid is an oxazolidinone antibiotic used in the treatment of infections caused by vancomycin-resistant enterococci. Resistance to linezolid has been associated with a G2576U mutation in domain V of the 23S rRNA.

Patient and methods: We present clinical details and susceptibility data from multiple Enterococcus faecium strains isolated from a liver transplant patient over 13 months. MICs of linezolid, vancomycin and quinupristin/dalfopristin were determined using Etest. Molecular typing was performed by pulsed-field gel electrophoresis. Domain V of the 23S rRNA gene in the vancomycin-resistant Enterococcus faecium was amplified. Linezolid concentrations were analysed by HPLC.

Results: We report the emergence of resistance to linezolid in a vancomycin-resistant Enterococcus faecium during linezolid treatment. After discontinuation of the linezolid therapy, the isolate reverted to susceptibility. However, after re-administration of linezolid the vancomycin-resistant Enterococcus faecium became resistant to linezolid again. The isolates that were resistant to linezolid had a G2576T mutation in their 23S rDNA.

Conclusion: We describe a clinical case that shows the shift of a vancomycin-resistant Enterococcus faecium from linezolid resistance to susceptibility and then back to resistance again related to linezolid therapy.

Keywords: resistance; pharmacokinetics; pharmacodynamics; liver transplantations; mutations

Journal Article.  1501 words. 

Subjects: Medical Oncology ; Critical Care

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