In vitro activity of linezolid against key gram-positive organisms isolated in the united states: results of the LEADER 2004 surveillance program

Abstract

Since the approval of linezolid in 2000, sporadic reports of resistance have been given and a greater understanding of the underlying mechanisms of resistance has been gained. However, since these developments, an updated status of the in vitro activity of linezolid against gram-positive organisms from the United States has not been reported. The LEADER 2004 surveillance initiative was undertaken to obtain current and representative data on the activity of linezolid against key species, including isolates with significant resistance phenotypes. Organisms were isolated during 2004 and included 2,872 Staphylococcus aureus, 496 coagulase-negative staphylococcus (CNS), 428 Enterococcus faecalis, 196 Enterococcus faecium, and 422 Streptococcus pneumoniae isolates. All S. aureus isolates (54.2% oxacillin resistant) were susceptible to linezolid (MIC90 = 2 microg/ml); MIC distributions were consistent, regardless of oxacillin or multidrug resistance status. For CNS, one nonsusceptible isolate was encountered (Staphylococcus epidermidis; MIC = 32 microg/ml), but overall, the MIC(90) (1 microg/ml) was lower than that obtained with S. aureus. For E. faecalis and E. faecium, 99.5% and 96.4% of isolates, respectively, were linezolid susceptible. Both species had an MIC90 of 2 microg/ml, and MIC distributions did not vary with the vancomycin susceptibility status of the populations analyzed. Linezolid nonsusceptibility was not encountered among the S. pneumoniae isolates. These findings indicate that linezolid nonsusceptibility has remained rare among staphylococci and uncommon and sporadic among enterococci. Nonetheless, careful and ongoing monitoring of the in vitro effectiveness of linezolid will be needed so that any changes to the current status may be detected as soon as possible.

FIG. 1.

Vancomycin and linezolid MIC distribution according to different S. aureus phenotype populations (top, MSSA; middle, MRSA; bottom, MDRSA). Vertical dashed lines indicate the current CLSI breakpoints. S, susceptible; NS, nonsusceptible (2).

FIG. 2.

Vancomycin and linezolid MIC distribution according to different CNS phenotype populations (top, methicillin-susceptible CNS; middle, methicillin-resistant CNS; bottom, MDR-CNS). Solid bars, vancomycin; hatched bars, linezolid. Vertical dashed lines indicate the current CLSI breakpoints. S, susceptible; NS, nonsusceptible (2).

FIG. 3.

Vancomycin and linezolid MIC distribution patterns for E. faecalis (top) and E. faecium (bottom). Solid bars, vancomycin; hatched bars, linezolid. Vertical dashed lines indicate the current CLSI breakpoints. S, susceptible; I, intermediate; R, resistant (2).

FIG. 4.

Levofloxacin and linezolid MIC distributions according to different S. pneumoniae phenotype populations. Solid bars, levofloxacin; hatched bars, linezolid; Pen-S, penicillin susceptible; Pen-NS, penicillin intermediate and resistant. Vertical dashed lines indicate the current CLSI breakpoints. S, susceptible; NS, nonsusceptible (2).