RESUMO
This study describes a clinical case of a 71-year-old male with a history of ischemic cardiomyopathy after left ventricular assist device (LVAD) endocarditis caused by methicillin-resistant Staphylococcus epidermidis (MRSE) and a rare linezolid-resistant Streptococcus sanguinis strain (MIC, 32 µg/ml). The patient received courses of several antimicrobial agents, including linezolid for 79 days. The S. sanguinis strain had mutations in the 23S rRNA (T2211C, T2406C, G2576T, C2610T) and an amino acid substitution (N56D) in L22 and exhibited cross-resistance to ribosome-targeting agents.
Assuntos
Acetamidas/farmacologia , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Endocardite Bacteriana/microbiologia , Oxazolidinonas/farmacologia , Infecções Estreptocócicas/microbiologia , Streptococcus/efeitos dos fármacos , Streptococcus/isolamento & purificação , Acetamidas/uso terapêutico , Idoso , Antibacterianos/uso terapêutico , Coinfecção/microbiologia , Humanos , Linezolida , Masculino , Mutação de Sentido Incorreto , Oxazolidinonas/uso terapêutico , Fenótipo , Mutação Puntual , RNA Ribossômico 23S/genética , Proteínas Ribossômicas/genética , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis/efeitos dos fármacos , Staphylococcus epidermidis/isolamento & purificaçãoRESUMO
We characterized the impact of removal of the ESBL designation from microbiology reports on inpatient antibiotic prescribing. Definitive prescribing of carbapenems decreased from 48.4% to 16.1% (P = .01) and ß-lactam-ß-lactamase inhibitor combination increased from 19.4% to 61.3% (P = .002). Our findings confirm the importance of collaboration between microbiology and antimicrobial stewardship programs.