Evaluation of the Emergence of the Resistance to Linezolid in Staphylococcus Epidermidis and Risk Factors Analysis : a Mono-centric Case-control Study
试验速览
- 阶段
- 不适用
- 入组人数
- 103
- 试验地点
- 1
- 主要终点
- linezolid-resistance
研究概览
简要总结
Understanding the emergence of linezolid-resistance in Staphylococci has been allowed in the past years through the discovery of the clonal dissemination of a chromosomal cassette carrying a modified crf gene. New mutations have even been described. Though, clinical evidences are still lacking, especially concerning the factors associated to this emergence. It could seriously become quite problematic to eliminate one of the last therapeutic weapon at our disposal for the treatment of severe or complicated infections caused by resistant strains of Staphylococci and Enterococci.
We aim to describe the mechanisms that permitted to this resistance to become clinically significant, concerning meticillin-resistant Staphyloccocus epidermidis strains causing blood stream infections in ICU patients, and show the clinical risk factors associated with it through a case-control study on patients hospitalized in two ICUs of our hospital between 2011 and 2016.
详细描述
Resistance to linezolid has been increasing in the past years, suggesting growing therapeutic difficulties while narrowing the options for treating severe or complicated infections involving Staphyloccoci or Enterococci strains. This emergence has been partially explained after the discovery of chromosomal dissemination of a particular gene, named "crf", conferring high level resistance to oxazolidinones.
Moreover, this mechanism has been showed as being prevalent in several countries across North America, Asia, and Europe.
But still the link with clinical evidences has not yet been very well established.
In particular the role of S. epidermidis has become clinically significant concerning blood stream infections and catheter-linked infections. The reality of the pathogenicity is more widely accepted, especially regarding prosthetic joint infections, and immunocompromised patient, as in hematology and oncology.
Thus, it appears necessary to provide more solid informations concerning the risk of using this antibiotic in a high burden setting of resistance, where it might be prescribed intensively on critical situations, and thus responsible for a high selection pressure of resistance.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Control
- 时间视角
- Other
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •all adult patient admitted in ICU between april 2011 and october 2016, diagnosed for a blood stream infection during the ICU stay, whatever the antibiotic therapy conducted before or after the diagnosis
排除标准
- •minor-aged patients
- •less than 2 blood cultures positive
- •blood cultures distant from more than 48 hours
- •cultures positive to distinct pathogens
结局指标
主要结局
linezolid-resistance
时间窗: within the 28 days after diagnosis of blood stream infection, or identification of the first blood culture positive with S. epdermidis
searching for risk factors associated with blood stream infection due to a linezolid-resistant S.epidemridis strain
次要结局
- mutations rate regarding crf gene(retrospective analysis, 1 to 5 years after blood stream infection diagnosis)
研究者
Paul-Henri WICKY
Medical Doctor
Centre Hospitalier Universitaire de Besancon