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Is linezolid a risk factor for Gram-negative bacillus infections in intensive care unit patients? A comparative study
Holger Sterzik1, Alejandro Soriano, Al-Montaser Mohamad
1Department of Internal Medicine, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Background:
Linezolid is frequently used in critically ill patients with ventilator-associated pneumonia. Its potent activity against Gram-positive microorganisms and its high tissue penetration may favour Gram-negative colonization and infection. The aim of our study was to evaluate the risk for Gram-negative infections in critically ill patients treated with linezolid or vancomycin.
Methods:
The cases of all patients admitted over an 18-month period to a hepatic intensive care unit for ≥ 1 week, and treated with linezolid or vancomycin, were retrospectively reviewed. The main clinical characteristics and infections due to Gram-negative bacteria in the month after starting linezolid or vancomycin were obtained.
Results:
Seventy-one patients treated with linezolid and 68 treated with vancomycin fulfilled the inclusion criteria. Co-morbidities were similar in both groups. Patients on linezolid treatment had a longer stay in the ICU (mean ± standard deviation 41 ± 38 days vs 18.4 ± 13 days), received this treatment later (14.3 ± 15.1 days vs 6.3 ± 6.5 days), had a higher mean serum creatinine concentration (1.71 ± 1.18 mg/dl vs 1.04 ± 1.04 mg/dl), more often required haemodiafiltration (29.6% vs 13.2%), and 30 day-mortality was higher (42.3% vs 20.6%) than in patients receiving vancomycin. More than 95% in both groups received a broad-spectrum beta-lactam in addition to linezolid or vancomycin. The rate of Gram-negative infection during the following month was 28.2% in the linezolid group and 26.5% in the vancomycin group (p > 0.5).
Conclusions:
Linezolid was more frequently used in critically ill patients with longer ICU stay and renal failure. The rate of infection due to Gram-negative microorganisms was similar in patients who received linezolid or vancomycin.
Insights
This study found that linezolid use in critically ill patients did not increase the risk of Gram-negative infections compared to vancomycin. Rates of Gram-negative infection were similar between the two antibiotic groups.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Linezolid is a common antibiotic for ventilator-associated pneumonia in critically ill patients.
- Its properties may increase the risk of Gram-negative bacterial colonization and infection.
- This study investigated this potential risk.
Purpose of the Study:
- To evaluate the risk of Gram-negative infections in critically ill patients treated with linezolid versus vancomycin.
- To compare clinical characteristics and infection rates between the two treatment groups.
Main Methods:
- Retrospective review of patients in a hepatic intensive care unit over 18 months.
- Inclusion criteria: ICU stay ≥ 1 week, treated with linezolid or vancomycin.
- Data collected: clinical characteristics and Gram-negative infections within one month of treatment initiation.
Main Results:
- 71 patients received linezolid, 68 received vancomycin; groups had similar comorbidities.
- Linezolid patients had longer ICU stays, later treatment initiation, higher creatinine, more haemodiafiltration, and higher 30-day mortality.
- The rate of Gram-negative infection was similar: 28.2% for linezolid vs. 26.5% for vancomycin (p > 0.5).
Conclusions:
- Linezolid was used more in patients with longer ICU stays and renal failure.
- The risk of Gram-negative infection was comparable between linezolid and vancomycin treatments.
- Antibiotic choice did not significantly alter Gram-negative infection rates in this cohort.
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