Linezolid for infective endocarditis: A structured approach based on a national database experience

Area of Science:

• Infectious Diseases
• Pharmacology
• Clinical Medicine

Background:

• Limited data exist on linezolid (LNZ) frequency and efficacy in infective endocarditis (IE).
• Previous studies relied on small retrospective series, necessitating larger database evaluations.

Purpose of the Study:

• To evaluate the effectiveness and impact of linezolid (LNZ) in patients with infective endocarditis (IE).
• To compare outcomes between LNZ treatment strategies and non-LNZ treated patients.

Main Methods:

• Retrospective analysis of the Spanish GAMES database for IE patients treated with LNZ.
• Categorization of LNZ treatment into <7 days, high-impact (≥7 days, >50% total treatment, >50% early doses), and non-high-impact (NHI).
• Propensity score matching and multivariate analysis comparing LNZ groups to controls, adjusting for comorbidities and IE characteristics.

Main Results:

• Of 3467 IE patients, 295 (8.5%) received LNZ. Most LNZ cases (61%) were LNZ-NHI, with only 3.7% classified as high-impact.
• In-hospital mortality rates were 51.5% (LNZ <7 days), 54.4% (LNZ high-impact), and 19.1% (LNZ-NHI).
• Propensity analysis showed higher in-hospital mortality in the LNZ high-impact group (54.5%) versus controls (18.2%). Multivariate analysis indicated LNZ use was independently associated with increased in-hospital mortality (OR 9.06).

Conclusions:

• Linezolid treatment for IE is frequent but rarely meets high-impact criteria.
• Current data suggest that using linezolid as definitive treatment for infective endocarditis may be linked to increased in-hospital mortality.