Resistencia al linezolid en Streptococcus pneumoniae: revisión sistemática

Abstract

Introduction: Antimicrobial resistance is an increasing public health challenge, particularly with Streptococcus pneumoniae, which is responsible for severe respiratory and systemic infections. Linezolid, a last-line antibiotic from the oxazolidinone group, remains effective against multidrug-resistant strains; however, the emergence of resistance threatens its efficacy. Analyzing its prevalence and characteristics is essential for clinical practice and epidemiological surveillance. Objective: To analyze linezolid resistance in S. pneumoniae reported between 2019 and 2024, describing genetic mechanisms, microbiological and clinical features, in addition to the drug’s in vitro activity. Methodology: A systematic review was conducted including clinical trials, cohort, and cross-sectional studies published between 2019 and 2024. Evidence quality was assessed using the National Institutes of Health (NIH), and Risk of Bias (RoB) was evaluated with Chrome, RoB 1, and RoB 2 according to study design. Data on prevalence, microbiological and clinical findings, and associated genes were collected. Results: Seventeen studies were included, with a global resistance rate of 3.42%. Resistant strains exhibited mutations in specific genes, with no significant clinical differences compared to susceptible strains. Linezolid’s in vitro activity remained high, confirming its efficacy. Limitations persist due to scarce regional data and the lack of longitudinal studies. Conclusion: Linezolid resistance in S. pneumoniae remains low, preserving therapeutic effectiveness. Nevertheless, the detection of genetic mechanisms, although infrequent, highlights the need for continuous surveillance and rational use. Implementing antimicrobial control programs and epidemiological monitoring is key to preventing the spread of resistant strains and ensuring effective treatments. Keywords: linezolid, antimicrobial resistance, Streptococcus pneumoniae, microbiological surveillance.