{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T23:23:52Z","timestamp":1771457032719,"version":"3.50.1"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2018,10,18]],"date-time":"2018-10-18T00:00:00Z","timestamp":1539820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K24 AI121296"],"award-info":[{"award-number":["K24 AI121296"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Vancomycin-resistant enterococci are an important cause of healthcare-associated infections and are inherently resistant to many commonly used antibiotics. Linezolid is the only drug currently approved by the US Food and Drug Administration to treat vancomycin-resistant enterococci; however, resistance to this antibiotic appears to be increasing. Although outbreaks of linezolid- and vancomycin-resistant Enterococcus faecium (LR-VRE) in solid organ transplant recipients remain uncommon, they represent a major challenge for infection control and hospital epidemiology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We describe a cluster of 4 LR-VRE infections among a group of liver and multivisceral transplant recipients in a single intensive care unit. Failure of treatment with linezolid in 2 cases led to a review of standard clinical laboratory methods for susceptibility determination. Testing by alternative methods including whole genome sequencing (WGS) and a comprehensive outbreak investigation including sampling of staff members and surfaces was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Review of laboratory testing methods revealed a limitation in the VITEK 2 system with regard to reporting resistance to linezolid. Linezolid resistance in all cases was confirmed by E-test method. The use of WGS identified a resistant subpopulation with the G2376C mutation in the 23S ribosomal RNA. Sampling of staff members\u2019 dominant hands as well as sampling of surfaces in the unit identified no contaminated sources for transmission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This cluster of LR-VRE in transplant recipients highlights the possible shortcomings of standard microbiology laboratory methods and underscores the importance of WGS to identify resistance mechanisms that can inform patient care, as well as infection control and antibiotic stewardship measures.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciy903","type":"journal-article","created":{"date-parts":[[2018,10,16]],"date-time":"2018-10-16T03:13:32Z","timestamp":1539659612000},"page":"259-265","source":"Crossref","is-referenced-by-count":25,"title":["Linezolid- and Vancomycin-resistant Enterococcus faecium in Solid Organ Transplant Recipients: Infection Control and Antimicrobial Stewardship Using Whole Genome Sequencing"],"prefix":"10.1093","volume":"69","author":[{"given":"Lilian","family":"Abbo","sequence":"first","affiliation":[{"name":"Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida"},{"name":"Department of Pharmacy Practice, School of Pharmacy, Presbyterian College, Clinton, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhavarth S","family":"Shukla","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amber","family":"Giles","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, School of Pharmacy, Presbyterian College, Clinton, South 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University of Miami Miller School of Medicine, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Sposato","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Truc T","family":"Tran","sequence":"additional","affiliation":[{"name":"Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Bogota, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorena","family":"Diaz","sequence":"additional","affiliation":[{"name":"Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Bogota, 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P","family":"Carvajal","sequence":"additional","affiliation":[{"name":"Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Cardozo","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maribel","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gemma","family":"Rosello","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, 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