• Muhammad Murad Ehsan
  • Ghulam Fatima
  • M. Owais Ismail
  • Zahida Memon


Background: Worldwide increase in antibiotic resistance has become one of the major problems. Optimal and rationale use of antibiotic is important to prevent resistance against most of the bacteria including Coagulase-negative Staphylococci (CoNS), which has now been recognized as an important pathogen for nosocomial infections. This study was carried out to determine efficacy of vancomycin and linezolid against CoNS in various clinical specimens. Methods: A total of 2989 specimens of blood, pus and wound swab were collected from wards, casualty, intensive care units (ICU) and out-patient department (O.P.D), out of these, Staphylococci were isolated in 1017 specimens, of which 381 were identified as CoNS. Culture, gram stain, catalase, coagulase test and antimicrobial susceptibility pattern were done on these specimens according to clinical manual of microbiology. A total of thirteen most commonly used antibiotics were used in this study. Susceptibility testing was done by Kirby Bauer disc diffusion technique. Results: Antimicrobial resistance of these isolates were Amoxicillin (74.8%), Amoxicillin+clavulanate (32.8%), Ciprofloxacin (35.2%), Ofloxacin (33.6%), Ceftriaxone (30.4%), Erythromycin (58.3%), Clindamycin (16.3%), Kanamycin (52.2%) Fusidic acid (41.7%), Doxycycline (24.7%), Vancomycin (2.6%) and Linezolid (0.8%) respectively. Isolates obtained from blood were 45.9%. Conclusion: Vancomycin showed resistance against CoNS which is a real threat for currently applied therapy against methicilin resistant CoNS. However, linezolid efficacy is higher than vancomycin against CoNS in our study, which suggests that this drug may be considered superior to vancomycin for the treatment of infections associated with CoNS.Keywords: Coagulase negative Staphylococci, Antibiotic resistance, Vancomycin, Linezolid


Ena J, Dick RW, Jones RN, Wenzel RP. The epidemiology of intravenous vancomycin usage in a university hospital. A 10-year study. JAMA 1993;269:598–602.

Abdel-Rahman SM, Kearns GL. An update on the oxazolidinone antibiotics. Pediatr Infect Dis J 1999;18:1101–2.

Tabe Y, Nakamura A, Igari J. Glycopeptide susceptibility profiles of nosocomial multiresistant Staphylococcus haemolyticus isolates. J Infect Chemother 2001;7(3):142–7.

Garrett DO, Jochimsen E, Murfitt K, Hill B, McAllister S, Nelson P, et al. The emergence of decreased susceptibility to vancomycin in Staphylococcus epidermidis. Infect Control Hosp Epidemiol 1999;20(3):167–70.

Siebert WT, Moreland N, Williams TW Jr. Synergy of vancomycin plus cefazolin or cephalothin against methicillin-resistance Staphylococcus epidermidis. J Infect Dis 1979;139:452–7.

Schwalbe RS Stapleton JT, Gilligan PH. Emergence of vancomycin resistance in coagulase-negative staphylococci. N Engl J Med. 1987;316:927–31.

Nakipoglu Y, Derbentli S, Cagatay AA, Katranci H. Investigation of Staphylococcus strains with heterogeneous resistance to glycopeptides in a Turkish university hospital. BMC Infect Dis 2005;5:31.

Cupo-Abbott J Louie SG, Rho JP. A synthetic oxazolidinone antimicrobial for treatment of serious grampositive infections. Formulary 2000;35:483–97.

Clemett D Markam A. Linezolid. Drugs 2000;59:815–27.

Weigelt J KH, Itani KM, Swanson RN. Linezolid eradicates MRSA better than vancomycin from surgical-site infections. Am J Surg. 2004;188:760–6.

An MM Shen H, Zhang JD, Xu GT, Jiang YY. Linezolid versus vancomycin for meticillin-resistant Staphylococcus aureus infection: a meta-analysis of randomised controlled trials. Int J Antimicrob Agents 2013;41:426–33.

Spencer RC. Predominant pathogens found in the European prevalence of infection in intensive care study. Eur J Clin Microbiol Infect Dis 1996;15:281–5.

Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–601.

Agvald-Ohman C, Wernerman J, Nord CE, Edlund C. Anaerobic bacteria commonly colonize the lower airways of intubated ICU patients. Clin Microbiol Infect 2003;9:397–405.

Ronveaux O, Jans B, Suetens C, Carsauw H. Epidemiology of nosocomial bloodstream infections in Belgium, 1992-1996. Eur J Clin Microbiol Infect Dis 1998;17:695–700.

Huebner J Goldmanna DA. Coagulase-negative staphylococci: role as pathogens. Annu Rev Med 1999;50:223–36.

Kiehlbauch JA, Hannett GE, Salfinger M, Archinal W, Monserrat C, Carlyn C. Use of the National Committee for Clinical Laboratory Standards Guidelines for disk diffusion susceptibility testing in New York State laboratories. J Clin Microbiol 2000;38(9):3341-8.

Sohn AH, Garrett DO, Sinkowitz-Cochran RL, Grohskopf LA, Levine GL, Stover BH, et al. Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr 2001;139:821–7.

Emori TG, Gaynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbial Rev 1993;6:428–42.

Sheikh AF, Mehdinejad M. Identification and determination of coagulase-negative Staphylococci species and antimicrobial susceptibility pattern of isolates from clinical specimens. Afr J Microbiol Res 2012;6:1669–74.

Bouchami O, Achour W, Ben Hassen A. Species distribution and antibiotic sensitivity pattern of coagulase-negative Staphylococci other than Staphylococcus epidermidis isolated from various clinical specimens. Afr J Microbiol Res 2011;5:1298–305.

Perveen I, Majid A, Knawal S, Naz I, Sehar S, Ahmed S, et al. Prevalence and Antimicrobial Susceptibility Pattern of Methicillin-Resistant Staphylococcus aureus and Coagulase-Negative Staphylococci in Rawalpindi, Pakistan. Br J Med Med Res 2013;3(1):198–209.

Khadri H, Alzohairy M. Prevalence and antibiotic susceptibility pattern of methicillin-resistant and coagulase-negative staphylococci in a tertiary care hospital in India. Int J Med Med Sci 2010;2(4):116–20.

Mohan U, Jindal, N, Aggarwal P. Species distribution and antibiotic sensitivity pattern of coagulase negative Staphylococci isolated from various clinicalspecimens. Indian J Med Microbiol 2002;20(1):45–6.

Sharma V, Jindal N. In Vitro Activity of Vancomycin and Teicoplanin Against Coagulase Negative Staphylococci. Oman Med J. 2011;26(3):186–8.

Sharma V, Jindal N, Devi P. Prevalence of methicillin resistant coagulase negative staphylococci in a tertiary care hospital. Iran J Microbiol 2010;2(4):185–8.

Sarathbabu R, Rajkumari N, Ramani TV. Characterization of Coagulase negative Staphylococci isolated from urine, pus, sputum and blood samples. Int J Pharm Sci Inven 2013;2:37–46.

Akinkunmi EO, Lamikanra A. Species Distribution and Antibiotic Resistance in Coagulase-negative Staphylococci Colonizing the Gastrointestinal Tract of Children in Ile-Ife, Nigeria. Trop J Pharm Res 2010;9(1):35–43.

Fajardo Olivares M, Hidalgo Orozco R, Rodríguez Garrido S, Gaona Alvarez C, Sanchez Silos RM, Hernandez Rastrollo R, et al. Activity of vancomycin, teicoplanin and linezolid in methicillin resistant coagulase-negative Staphylococci isolates from paediatric blood cultures. Rev Esp Quimioter 2012;25:25–30