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Linezolid versus daptomycin treatment for periprosthetic joint infections: a retrospective cohort study
Masahiro Sawada1, Kenichi Oe2, Masayuki Hirata1
1Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
Background:
Linezolid (LZD) and daptomycin (DAP) are predominantly used to target gram-positive pathogens; however, treatment effectiveness and adverse reactions for periprosthetic joint infections (PJIs) remain unknown. The aim of this study was to compare the effectiveness and adverse reactions of LZD and DAP for PJIs.
Methods:
This study retrospectively evaluated 82 patients between June 2009 and December 2017, to compare the effectiveness of LZD (group L, n = 39) and DAP (group D, n = 43) for treatment of PJIs harboring gram-positive microorganisms. Surgical options used with LZD or DAP therapy included implant retention, implant removal, and a shift to another appropriate antibiotic. Infection control was defined as not requiring implant removal after the final treatment.
Results:
Gram-positive pathogens were isolated from 72% of group L and 70% of group D patients, respectively. Whole infection control rates against gram-positive pathogens in groups L and D were 79% and 77%, respectively. Furthermore, infection control rates were 94% and 58% in group L and 75% and 80% in group D, without and with implant removal, respectively. Significantly higher clinical success rates and lower adverse event rates were observed in group D, including higher red blood cell and platelet counts and lower C-reactive protein (CRP) levels.
Conclusions:
Although the effectiveness of LZD and DAP was equivalent in terms of infection control rates for refractory PJIs with gram-positive pathogens, DAP therapy significantly decreased CRP levels and caused fewer adverse events than LZD treatment.
Insights
Daptomycin (DAP) and Linezolid (LZD) are effective for periprosthetic joint infections (PJIs). DAP showed similar infection control but fewer adverse events and lower C-reactive protein (CRP) levels compared to LZD.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Pharmacology
Background:
- Periprosthetic joint infections (PJIs) are serious complications requiring effective antimicrobial therapy.
- Linezolid (LZD) and daptomycin (DAP) are key antibiotics for gram-positive pathogens but their comparative efficacy in PJIs is not well-established.
- Understanding treatment outcomes and adverse events is crucial for optimizing PJI management.
Purpose of the Study:
- To compare the effectiveness and adverse reactions of Linezolid (LZD) and Daptomycin (DAP) in treating periprosthetic joint infections (PJIs).
- To evaluate infection control rates and clinical success in patients with gram-positive PJIs treated with LZD or DAP.
- To assess the impact of these antibiotics on inflammatory markers and patient safety.
Main Methods:
- Retrospective evaluation of 82 patients with PJIs caused by gram-positive microorganisms from June 2009 to December 2017.
- Patients were divided into two groups: LZD (n=39) and DAP (n=43).
- Treatment strategies included implant retention, removal, or antibiotic switch; infection control was defined by the absence of implant removal post-therapy.
Main Results:
- Gram-positive pathogens were prevalent in both groups (72% LZD, 70% DAP).
- Overall infection control rates were comparable (79% LZD, 77% DAP).
- Daptomycin (DAP) group demonstrated significantly higher clinical success rates, lower adverse event rates, improved red blood cell and platelet counts, and reduced C-reactive protein (CRP) levels compared to the Linezolid (LZD) group.
Conclusions:
- Linezolid (LZD) and Daptomycin (DAP) offer equivalent infection control for refractory PJIs caused by gram-positive pathogens.
- Daptomycin (DAP) therapy is associated with significantly lower C-reactive protein (CRP) levels and fewer adverse events than Linezolid (LZD) treatment.
- Daptomycin (DAP) may be a preferred option for managing gram-positive PJIs due to its improved safety profile and inflammatory marker reduction.
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