Efficacy and safety of linezolid for Gram-positive orthopedic infections: a prospective case series

Diagn Microbiol Infect Dis. 2007 Oct;59(2):173-9. doi: 10.1016/j.diagmicrobio.2007.04.006. Epub 2007 Jun 15.

Abstract

Linezolid is an attractive alternative for orthopedic infections because of oral bioavailability and activity against methicillin-resistant staphylococci and vancomycin-resistant enterococci. To determine efficacy and safety, we prospectively monitored 51 consecutive adults who were not vancomycin candidates and who received linezolid for 53 Gram-positive orthopedic infections, usually chronic osteomyelitis (n = 25) or prosthetic joint infection (n = 23). Pathogens were usually Staphylococcus aureus (n = 27) or coagulase-negative staphylococci (n = 19); 38 were methicillin resistant. After remission, 17 infections required long-term suppression, usually because of retained hardware. Clinical and microbiologic failure occurred in only one patient. The most common adverse events were thrombocytopenia (n = 5) and anemia (n = 5), necessitating treatment discontinuation in 3 patients. One patient developed reversible optic and irreversible peripheral neuropathy after 24 months of linezolid. Linezolid, with surgery, may be a reasonable alternative for Gram-positive orthopedic infections. We recommend weekly hematologic monitoring, and, if therapy lasts >2 months, periodic ophthalmologic monitoring.

MeSH terms

  • Acetamides / adverse effects
  • Acetamides / therapeutic use
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Infective Agents* / adverse effects
  • Anti-Infective Agents* / therapeutic use
  • Chronic Disease
  • Female
  • Gram-Positive Bacteria / classification
  • Gram-Positive Bacteria / drug effects*
  • Gram-Positive Bacterial Infections / drug therapy*
  • Gram-Positive Bacterial Infections / microbiology
  • Humans
  • Linezolid
  • Male
  • Middle Aged
  • Orthopedics
  • Osteomyelitis / drug therapy*
  • Osteomyelitis / microbiology
  • Oxazolidinones / adverse effects
  • Oxazolidinones / therapeutic use
  • Prospective Studies
  • Prosthesis-Related Infections / drug therapy*
  • Prosthesis-Related Infections / microbiology
  • Treatment Outcome

Substances

  • Acetamides
  • Anti-Infective Agents
  • Oxazolidinones
  • Linezolid