High rate of linezolid intermediate susceptibility and resistance among enteric vancomycin-resistant Enterococcus (VRE) recovered from hospitalized patients actively screened for VRE colonization

Patients at risk for enteric vancomycin-resistant Enterococcus (VRE) colonization may be actively screened for VRE colonization to inform infection prevention practices and empiric antibiotic therapy.1 However, daptomycin nonsusceptible (DNS) and linezolid non-susceptible (LNS; including linezolid-intermediate or -resistant) VRE is of concern.2,3 At our hospital, surgical intensive care unit and liver transplant patients are actively screened for VRE colonization. Patient Demographics and Subsequent Infectionsa Variable All Patients (n=86) Linezolid Susceptible (n=28) Linezolid Nonsusceptible (n=58) P Valueb Age mean y ± standard deviation 59 ± 13 57 ± 15 59 ± 12 .1257 Male gender 51 (59.3) 19 (67.9) 32 (55.2) .3498 Race Caucasian 68 (79.1) 21 (75.0) 47 (81.0) .5766 African-American 15 (17.4) 6 (21.4) 9 (15.5) .5506 Other 3 (3.5) 1 (3.6) 2 (3.5) >.9999 Previous abdominal transplant 12 (14.0) 4 (14.3) 8 (13.8) >.9999 Actively listed for abdominal transplant 12 (14.0) 4 (14.3) 8 (13.8) >.9999 Previous VRE infection 30 (34.9) 12 (42.9) 18 (31.0) .3372 No. of previous VRE infections 0 (0–1) 0 (0–1) 0 (0,1) .3868 No. of hospital units before VRE collection 3 (2–5) 2 (2–4) 3 (1,5) .4033 No. of inpatient hospitalizationsc 3 (2–5) 4 (2–6) 3 (2,5) .2853 No. of inpatient daysc 20 (9–39) 33 (12–47) 17 (9,32) .0800 Length of stay before VRE collectiond 1 (0–6) 0.5 (0–3.5) 1 (0,6) .4309 All-cause mortality, 30 d after VRE collection 21 (24.4) 5 (17.9) 16 (27.6) .3200 Subsequent VRE infectiond,e 10 (11.6) 1 (3.5) 9 (15.5) .1560 Subsequent bacterial infection (including VRE)d 25 (29.0) 5 (17.9) 20 (34.5) .1342 Subsequent Clostridioides difficile infectionf 3 (3.5) 1 (3.6) 2 (3.4) >.9999 Note. VRE, vancomycin-resistant Enterococcus. a All data presented as median (interquartile range) or no. (%) unless otherwise noted. b Comparison between linezolid susceptible and linezolid nonsusceptible groups. c To any hospital within the health system within 2 years before VRE isolate collection. d Within 30 days after VRE collection. e Two patients in the linezolid nonsusceptible group developed a bacterial infection after liver transplant. f Defined as a positive C. difficile toxin PCR with antibiotic treatment for C. difficile within 30 days after VRE collection.