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Journal of Clinical Microbiology, March 2008, p. 892-896, Vol. 46, No. 3
0095-1137/08/$08.00+0     doi:10.1128/JCM.01886-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Clinical and Microbiological Aspects of Linezolid Resistance Mediated by the cfr Gene Encoding a 23S rRNA Methyltransferase

Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia,¹ Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, Texas,² Hospital General,³ Universidad Pontificia Bolivariana, Medellín, Colombia,⁴ Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia,⁵ Centro Internacional de Entrenamiento e Investigaciones Médicas, Cali, Colombia,⁶ Center for the Study of Emerging and Reemerging Pathogens,⁷ Department of Microbiology and Molecular Genetics, University of Texas Medical School at Houston, Houston, Texas,⁸ Rush University Medical Center, Chicago, Illinois,⁹ Chicago Infectious Disease Institute, Chicago, Illinois,¹⁰

Received 21 September 2007/ Returned for modification 7 December 2007/ Accepted 24 December 2007

The cfr (chloramphenicol-florfenicol resistance) gene encodes a 23S rRNA methyltransferase that confers resistance to linezolid. Detection of linezolid resistance was evaluated in the first cfr-carrying human hospital isolate of linezolid and methicillin-resistant Staphylococcus aureus (designated MRSA CM-05) by dilution and diffusion methods (including Etest). The presence of cfr was investigated in isolates of staphylococci colonizing the patient's household contacts and clinical isolates recovered from patients in the same unit where MRSA CM-05 was isolated. Additionally, 68 chloramphenicol-resistant Colombian MRSA isolates recovered from hospitals between 2001 and 2004 were screened for the presence of the cfr gene. In addition to erm(B), the erm(A) gene was also detected in CM-05. The isolate belonged to sequence type 5 and carried staphylococcal chromosomal cassette mec type I. We were unable to detect the cfr gene in any of the human staphylococci screened (either clinical or colonizing isolates). Agar and broth dilution methods detected linezolid resistance in CM-05. However, the Etest and disk diffusion methods failed to detect resistance after 24 h of incubation. Oxazolidinone resistance mediated by the cfr gene is rare, and acquisition by a human isolate appears to be a recent event in Colombia. The detection of cfr-mediated linezolid resistance might be compromised by the use of the disk diffusion or Etest method.

Published ahead of print on 3 January 2008.

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