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Case summary details a 16-year-old with high-risk B-cell acute lymphoblastic leukemia whose VRE urinary tract infection showed discordant linezolid susceptibility across platforms and rising MICs for linezolid and chloramphenicol, suggesting ribosomal-target-mediated resistance. Conclusion emphasizes diagnostic challenges, need for rapid accurate susceptibility testing, and access to confirmatory or molecular methods to guide therapy.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/linezolid-resistant-and-vancomycin-resistant-enterococcus-faecium-urinary-isolate-in-a-pediatric-b-all-patient/444596/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/linezolid-resistant-and-vancomycin-resistant-enterococcus-faecium-urinary-isolate-in-a-pediatric-b-all-patient/444596.png","ImageObject",300,407,{"name":42,"@type":43},"Franzy","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-01","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":26},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"Why 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urinary isolate in a pediatric B-ALL patient  \nEmma Seevak,1 Tanvi S. Sharma,1,2 Alaric W. D'Souza1,2,3 AUTHOR AFFILIATIONS See affiliation list on p. 5.  \nABSTRACT  \nBackground Vancomycin-resistant Enterococcus faecium (VRE) is a major cause of healthcare-associated infections, especially in immunocompromised hosts. Linezolid is a key therapeutic agent due to its oral bioavailability and activity against resistant Gram-positive bacteria. While rare in U.S. pediatric patients, linezolid resistance can severely limit treatment options.  \nCase Summary We describe a 16-year-old female with high-risk B-cell acute lymphoblastic leukemia whose hospitalization was complicated by urinary tract infection with VRE. Serial isolates tested on multiple antimicrobial susceptibility testing platforms yielded discordant results for linezolid susceptibility. Minimum inhibitory concentrations to linezolid and chloramphenicol increased together, suggesting potential ribosomal-target-mediated resistance. She ultimately required daptomycin therapy for linezolid-resistant VRE urinary tract infection treatment.  \nConclusion This case underscores the diagnostic challenges in detecting emerging linezolid resistance in E. faecium, particularly in immunocompromised patients. Accurate, timely susceptibility testing and improved access to confirmatory or molecular diagnostics are essential to guide therapy for VRE where linezolid remains one of the few viable therapeutic options.  \nKEYWORDS immunocompromised, pediatrics, urinary tract infection, vancomycin resistance, antibiotic resistance, linezolid, VRE  \nE nterococcus faecium is a leading cause of nosocomial infections, particularly among  \nimmunocompromised patients, and has developed resistance to many standard therapies (1, 2) . Vancomycin-resistant E. faecium (VRE) presents a significant management challenge, and linezolid is frequently used for treatment (3–6) . Linezolid is an oxazolidinone antibiotic that inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit at the peptidyl transferase center, preventing formation of the initiation complex essential for translation (7–9) . Linezolid and daptomycin are common alternatives to vancomycin for resistant Gram-positive infections, but linezolid’s oral bioavailability and central nervous system and lung penetration are strengths over daptomycin (10–12) .  \nMultiple mechanisms can confer linezolid resistance in Gram-positive organisms, including (i) ribosomal mutations in 23S rRNA and/or L3/L4/L22 ribosomal proteins, (ii) loss of the rlmN gene (which encodes a RNA methyltransferase), (iii) efflux pumps, (iv) Cfr and Cfr-like methyltransferases, and (v) ribosomal protection proteins (OptrA, PotxA, and PotxA2) (13). Though still relatively uncommon, linezolid resistance is increasing (14), particularly in oncology and transplant populations with high antimicrobial exposure  \nEditor Nicholas M. Moore, Rush University Medical Center, Chicago, Illinois, USA  \nAddress correspondence to Alaric W. D'Souza, [alaric.dsouza@childrens.harvard.edu](alaric.dsouza@childrens.harvard.edu).  \nauthors declare conflict of interest  \nand healthcare contact (15) . Outbreaks of linezolid-resistant VRE have been reported in U.S. academic medical centers, including in patients without prior linezolid exposure (16, 17) . Pediatric reports of linezolid resistance remain rare, but early cases highlight the risk of losing one of the few reliable oral antimicrobials for serious Gram-positive infections (18) .  \nDetection of emerging resistance is complicated by variability between testing platforms, such as automated systems (e.g. VITEK 2 [bioMérieux], BD Phoenix [BD]) and manual methods (e.g. ETEST) (19) . Both VITEK 2 and Phoenix use broth microdilution-based methodologies to infer minimum inhibitory concentrations (MICs) from growth kinet","cbCaihE3mFHAmZ3L","https://ap.wps.com/l/cbCaihE3mFHAmZ3L","pdf",410766,"English","# Abstract\n## Background\n## Case Summary\n## Conclusion\n# Case Presentation\n## Patient history and leukemia treatment\n## Hospital course and infection development","[{\"question\":\"Why is linezolid important for treating resistant Enterococcus faecium infections in children?\",\"answer\":\"Linezolid is a key therapeutic agent because it is orally bioavailable and active against resistant Gram-positive bacteria, making it a valuable option when vancomycin resistance limits alternatives.\"},{\"question\":\"What problem did clinicians face when testing linezolid susceptibility in this case?\",\"answer\":\"Serial isolates produced discordant linezolid susceptibility results across multiple antimicrobial susceptibility testing platforms, complicating interpretation near clinical decision points.\"},{\"question\":\"What treatment was ultimately required for the linezolid-resistant VRE urinary tract infection?\",\"answer\":\"The patient required daptomycin therapy after linezolid-resistant VRE was implicated in the urinary tract infection.\"}]","Linezolid-resistant and vancomycin-resistant Enterococcus faecium urinary isolate in a pediatric B-ALL patient | PDF",1790708588,15]