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Linezolid for therapy of Staphylococcus aureus meningitis: a cohort study of 26 patients
Vicente Pintado1, Rosario Pazos1,2, Manuel Enrique Jiménez-Mejías3
1Infectious Diseases Service, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
Background:
Linezolid has good penetration to the meninges and could be an alternative for treatment of Staphylococcus aureus meningitis. We assessed the efficacy and safety of linezolid therapy for this infection.
Methods:
Retrospective multicenter cohort study of 26 adults treated with linezolid, derived from a cohort of 350 cases of S. aureus meningitis diagnosed at 11 university hospitals in Spain (1981-2015).
Results:
There were 15 males (58%) and mean age was 47.3 years. Meningitis was postoperative in 21 (81%) patients. The infection was nosocomial in 23 (88%) cases, and caused by methicillin-resistant S. aureus in 15 cases and methicillin-susceptible S. aureus in 11. Linezolid was given as empirical therapy in 10 cases, as directed therapy in 10, and due to failure of vancomycin in 6. Monotherapy was given to 16 (62%) patients. Median duration of linezolid therapy was 17 days (IQR 12-22 days) with a daily dose of 1,200 mg in all cases. The clinical response rate to linezolid was 69% (18/26) and microbiological response was observed in 14 of 15 cases evaluated (93%). Overall 30-day mortality was 23% and was directly associated with infection in most cases. When compared with the patients of the cohort, no significant difference in mortality was observed between patients receiving linezolid or vancomycin for therapy of methicillin-resistant S. aureus meningitis (9% vs. 20%; p = .16) nor between patients receiving linezolid or cloxacillin for therapy of methicillin-susceptible S. aureus meningitis (20% vs 14%; p = .68). Adverse events appeared in 14% (3/22) of patients, but linezolid was discontinued in only one patient.
Conclusions:
Linezolid appears to be effective and safe for therapy of S. aureus meningitis. Our findings showed that linezolid may be considered an adequate alternative to other antimicrobials in meningitis caused by S. aureus.
Insights
Linezolid is an effective and safe treatment option for Staphylococcus aureus meningitis. This study found it comparable to other antibiotics, making it a viable alternative for this serious infection.
Area of Science:
- Infectious Diseases
- Neurology
- Pharmacology
Background:
- Staphylococcus aureus meningitis is a serious infection.
- Linezolid demonstrates good penetration into the meninges.
- Assessing linezolid's efficacy and safety in treating S. aureus meningitis is crucial.
Purpose of the Study:
- To evaluate the effectiveness of linezolid in treating Staphylococcus aureus meningitis.
- To assess the safety profile of linezolid therapy for this condition.
- To determine if linezolid is a suitable alternative to existing treatments.
Main Methods:
- Retrospective multicenter cohort study.
- Involved 26 adult patients treated with linezolid for S. aureus meningitis.
- Data collected from 11 Spanish university hospitals between 1981 and 2015.
Main Results:
- Clinical response to linezolid was 69%, with a 93% microbiological response rate.
- Linezolid showed comparable mortality rates to vancomycin (MRSA) and cloxacillin (MSSA).
- Adverse events were infrequent, with only one discontinuation.
Conclusions:
- Linezolid is effective and safe for treating Staphylococcus aureus meningitis.
- It can be considered an adequate alternative antimicrobial therapy.
- Supports the use of linezolid in specific cases of S. aureus meningitis.
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