Antimicrobial stewardship and linezolid

Area of Science:

• Infectious Diseases
• Antimicrobial Resistance
• Hospital Pharmacy

Background:

• Linezolid, an oxazolidinone antibiotic, has seen widespread use since 2002, often beyond approved indications.
• Concerns exist regarding linezolid-resistant organisms and the drug's high cost in healthcare settings.

Purpose of the Study:

• To evaluate the impact of an antimicrobial stewardship team (AST) on controlling linezolid over-prescription.
• To assess changes in linezolid use based on defined daily doses (DDD) per 1,000 inhabitants per day.

Main Methods:

• A retrospective and prospective study conducted in a 1,495-bed hospital from 2009 to 2013.
• An AST comprising pharmacy, microbiology, and infectious diseases departments monitored linezolid prescriptions.
• Defined daily dose (DDD) per 1,000 inhabitants per day was used to track consumption and compare with other hospitals.

Main Results:

• Over 2009-2013, 239 patients were evaluated; 45% of prescriptions were off-label, and 60% were deemed appropriate.
• Interventions led to modification or discontinuation of unsuitable treatments in 62% and 38% of cases, respectively.
• Mean linezolid treatment duration was 8 days, below the national average; DDD per 1,000 inhabitants per day remained lower than in 11 other French hospitals.

Conclusions:

• A multidisciplinary strategy involving therapeutic education and delivery control improved appropriate linezolid use.
• This approach can be extended to other critical antibiotics like carbapenems to manage costs and prevent resistance.