title: Characterization of coagulase-negative staphylococcal isolates from blood with reduced susceptibility to glycopeptides and therapeutic options.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Intensive Care Unit, Department of Surgery, Tor Vergata University of Rome, Rome, Italy. silvia.natoli@ptvonline.it
authors.forename: Silvia
authors.initials: S
authors.lastname: Natoli
authors.forename: Carla
authors.initials: C
authors.lastname: Fontana
authors.forename: Marco
authors.initials: M
authors.lastname: Favaro
authors.forename: Alberto
authors.initials: A
authors.lastname: Bergamini
authors.forename: Gian Piero
authors.initials: GP
authors.lastname: Testore
authors.forename: Silvia
authors.initials: S
authors.lastname: Minelli
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Bossa
authors.forename: Mauro
authors.initials: M
authors.lastname: Casapulla
authors.forename: Giorgia
authors.initials: G
authors.lastname: Broglio
authors.forename: Angela
authors.initials: A
authors.lastname: Beltrame
authors.forename: Laura
authors.initials: L
authors.lastname: Cudillo
authors.forename: Raffaella
authors.initials: R
authors.lastname: Cerretti
authors.forename: Francesca
authors.initials: F
authors.lastname: Leonardis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054458:Amplified Fragment Length Polymorphism Analysis; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015373:Bacterial Typing Techniques; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D006020:Glycopeptides / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000097:blood* / Q000188:drug therapy; D013212:Staphylococcus epidermidis / Q000145:classification / Q000187:drug effects / Q000235:genetics*; D041162:Staphylococcus haemolyticus / Q000145:classification / Q000187:drug effects / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D006020:Glycopeptides