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Nonmutational resistance to linezolid is due to the presence ofcfr , which encodes a methyltransferase responsible for methylation of A2503 in the 23S rRNA. Thecfr gene was first described in animal isolates of staphylococci, and more recently, it has been identified inStaphylococcus aureus from human clinical infections, including in an outbreak of methicillin-resistantS. aureus . In enterococci,cfr has been described in an animal isolate ofEnterococcus faecalis from China. Here, we report an isolate of linezolid-resistantE. faecalis (603-50427X) recovered from a patient in Thailand who received prolonged therapy with the antibiotic for the treatment of atypical mycobacterial disease. The isolate lacked mutations in the genes coding for 23S rRNA and L3 and L4 ribosomal proteins and belonged to the multilocus sequence type (MLST) 16 (ST16), which is commonly found in enterococcal isolates from animal sources. Resistance to linezolid was associated with the presence ofcfr on an ∼97-kb transferable plasmid. Thecfr gene environment exhibited DNA sequences similar to those of othercfr -carrying plasmids previously identified in staphylococci (nucleotide identity, 99 to 100%). Thecfr -carrying plasmid was transferable by conjugation to a laboratory strain ofE. faecalis (OG1RF) but not toEnterococcus faecium orS. aureus . Thecfr gene was flanked by IS256 -like sequences both upstream and downstream. This is the first characterization of the potential horizontal transferability of thecfr gene from a human linezolid-resistant isolate ofE. faecalis .

Transferable Plasmid-Mediated Resistance to Linezolid Due to cfr in a Human Clinical Isolate of Enterococcus faecalis