Linezolid therapy for orthopedic infections

September 12, 2004

Abstract from Mayo Clin Proc. 2004 Sep;79(9):1137-44.

Linezolid therapy for orthopedic infections.

Razonable RR, Osmon DR, Steckelberg JM.

Division of Infectious Diseases and Internal Medicine, Mayo Clinic

College of Medicine, Rochester, Minn 55905, USA.

OBJECTIVE: To assess the clinical and bacteriological efficacy and the

safety and tolerability profile of linezolid when used as the primary

component of a combined surgical and antimicrobial treatment strategy

for orthopedic infections.

PATIENTS AND METHODS: We retrospectively reviewed medical records to

obtain clinical, bacteriological, and safety outcomes of 20 consecutive

patients who took linezolid for the treatment of orthopedic infections

between April 1, 2000, and November 30, 2002.

RESULTS: Twenty patients received linezolid therapy for

microbiologically confirmed orthopedic infections due to gram-positive

cocci during the 32-month study period. Fifteen patients (75%) had

infections involving orthopedic hardware; in 10 of these patients, the

hardware was removed. All 20 patients underwent surgical debridement. At

a mean follow-up of 276 days, 11 patients (55%) achieved clinical cure,

7 (35%) had clinical improvement but received long-term antimicrobial

suppressive therapy, 1 (5%) had clinical relapse after discontinuing

linezolid treatment, and 1 (5%) died of a cause unrelated to linezolid

treatment. Bacterial persistence was documented in 3 patients (15%), all

of whom were Infected with methicillin-resistant Staphylococcus aureus.

Eight patients (40%) developed reversible myelosuppression, 1 (5%) had

irreversible peripheral neuropathy, and 2 (10%) discontinued linezolid

treatment because of pancytopenia or urticaria.

CONCLUSION: Oral linezolid may be an effective alternative therapy for

orthopedic infections due to linezolid-susceptible gram-positive

bacteria in patients who are unable to take other antimicrobial drugs

because of drug allergy or Intolerance or antimicrobial resistance.

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