Linezolid-resistant Enterococcus (LRE) faecium from blood culture of an adult burns patient: First report of LRE from Mumbai

Sir, Linezolid is an oxazolidone antibiotic used for treating infections due to Gram-positive cocci. There have been reports of emerging linezolid resistance in complicated enterococcal infections.[1] The first report of nosocomial transmission of linezolid-resistant Enterococcus (LRE) faecium was from Mayo Clinic, USA.[2] We reported the first documented case of LRE from Mumbai. A 36-year-old male was admitted to a tertiary care hospital in Mumbai with history of electric burns. Extensive debridement of both upper and lower limbs was done. He was started on injection meropenem and metronidazole. After 10 days of admission, the patient developed intermittent spikes of fever, and his blood was sent for culture. The blood culture grew E. faecium, resistant to both vancomycin and linezolid. Minimum inhibitory concentration (MIC) of vancomycin was >32 µg/ml and linezolid MIC >8 µg/ml. It also exhibited high-level aminoglycoside resistance. The first and only reported case of LRE faecium from India was from Kolkata in 2015, with no history of prior linezolid medication.[3] LRE has been reported even without prior exposure, and asymptomatic colonization has also been documented.[4] A nosocomial transmission of LRE may be a possibility in our patient. Resistance to linezolid is a matter of grave concern. Indiscriminate use of linezolid and its availability as an oral preparation may contribute to the development of resistance. Rational use of linezolid and avoiding long-term therapy with linezolid should be the objective of every treating physician. Sincere efforts are also needed for specific infection control measures for LRE. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.