The emerging problem of linezolid-resistant Staphylococcus

The oxazolidinone antibiotic linezolid has demonstrated potent antimicrobial activity against Gram-positive bacterial pathogens, including methicillin-resistant staphylococci. This article systematically reviews the published literature for reports of linezolid-resistant Staphylococcus (LRS) infections to identify epidemiological, microbiological and clinical features for these infections. Linezolid remains active against 98 of Staphylococcus, with resistance identified in 0.05 of Staphylococcus aureus and 1.4 of coagulase-negative Staphylococcus (CoNS). In all reported cases, patients were treated with linezolid prior to isolation of LRS, with mean times of 20.047.0 months for S. aureus and 11.08.0 days for CoNS. The most common mechanisms for linezolid resistance were mutation (G2576T) to the 23S rRNA (63.5 of LRSA and 60.2 of LRCoNS) or the presence of a transmissible cfr ribosomal methyltransferase (54.5 of LRSA and 15.9 of LRCoNS). The emergence of linezolid resistance in Staphylococcus poses significant challenges to the clinical treatment of infections caused by these organisms, and in particular CoNS.