Treatment of prosthetic valve infective endocarditis due to multi-resistant Gram-positive bacteria with linezolid

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Experimental Endocarditis Model of Methicillin Resistant Staphylococcus aureus (MRSA) in Rat
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Experimental Endocarditis Model of Methicillin Resistant Staphylococcus aureus (MRSA) in Rat

Published on: June 4, 2012

D W Wareham1, H Abbas, A M Karcher

  • 1Department of Medical Microbiology, Barts and The London NHS Trust, London E1 1BB, UK.

The Journal of Infection
|August 16, 2005
PubMed
Abstract

Insights

Linezolid is a viable treatment for infective endocarditis (IE) caused by resistant Gram-positive bacteria, even when bacteriostatic. This study shows clinical success and challenges the need for bactericidal synergy in IE treatment.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Bacteriology

Background:

  • Limited clinical data exist for linezolid in treating infective endocarditis (IE).
  • Multi-resistant Gram-positive bacteria pose a significant challenge in IE management.

Observation:

  • Two patients with IE, one caused by methicillin-resistant Staphylococcus epidermidis (MRSE) and another by vancomycin-resistant Enterococcus (VRE), were treated with linezolid-containing regimens.
  • In vitro studies analyzed the killing kinetics of linezolid in combination with gentamicin or vancomycin against relevant bacterial isolates.

Findings:

  • Both patients demonstrated clinical response and eradication of bacteremia with linezolid therapy.
  • Linezolid exhibited bacteriostatic activity against the MRSE and VRE isolates.
  • Combination therapy with gentamicin or vancomycin showed minimal additive effects, without synergy or antagonism.

Implications:

  • Linezolid offers a crucial therapeutic option for IE caused by multi-resistant Gram-positive pathogens.
  • The findings challenge the established notion that bactericidal synergy is essential for effective Gram-positive IE treatment.

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