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Published on: August 30, 2018
Effects of linezolid on the haematological system in very low birth weight infants: A single-centre retrospective
1Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
Insights
Linezolid use in very low birth weight (VLBW) infants may temporarily lower white blood cell and platelet counts compared to vancomycin. However, it does not increase severe hematologic side effects in this vulnerable population.
Area of Science:
- Neonatal Medicine
- Pharmacology
- Hematology
Background:
- Linezolid is an alternative to vancomycin for treating Gram-positive bacterial infections in very low birth weight (VLBW) infants.
- Concerns exist regarding linezolid-induced thrombocytopenia in adults, prompting investigation into its hematologic effects in VLBW infants.
Purpose of the Study:
- To evaluate the impact of linezolid on hematologic profiles in VLBW infants.
- To compare the hematologic effects of linezolid with vancomycin in VLBW infants.
Main Methods:
- Retrospective analysis of VLBW infants treated with linezolid (n=40) versus vancomycin (control, n=45) from January 2017 to July 2021.
- Comparison of hematologic parameters on Days 1, 3, 5, 7, 10, 14, and 21 post-medication initiation.
Main Results:
- Linezolid group showed significantly lower white blood cell counts on Days 5 and 7 (p=0.013 and p=0.01, respectively).
- Platelet counts were significantly lower in the linezolid group on Days 10 and 14 (p=0.049 and p=0.036, respectively).
- No significant differences in severe hematologic abnormalities like leukopenia, neutropenia, agranulocytosis, or thrombocytopenia were observed between groups.
Conclusions:
- Linezolid use in VLBW infants is associated with transient reductions in white blood cell and platelet counts compared to vancomycin.
- Linezolid does not appear to elevate the risk of severe hematologic side effects in this population.
What Is Known And Objective:
Linezolid, as a substitute for vancomycin, has been used in treating methicillin-resistant Gram-positive bacterial infections in very low birth weight (VLBW) infants. However, when linezolid induces thrombocytopenia in adults, its side effects in VLBW infants are concerning. This study aimed to investigate the effect of linezolid on haematologic profiles in this specific vulnerable population.
Methods:
VLBW infants treated with linezolid from January, 2017, to July, 2021, were retrospectively analysed compared with vancomycin as controls. The effects of medications on haematologic parameters were compared on Days 1, 3, 5, 7, 10, 14 and 21 after medication initiation.
Result And Discussion:
Totally 40 VLBW infants treated with linezolid were recruited in the study, using 45 VLBW treated with vancomycin as controls. Baseline clinical characteristics, such as gestational age and birth weight, were not significantly different between the two groups. After medication initiation, the white blood cell counts on the Days 5 and 7 in the linezolid group were significantly lower than that in the vancomycin group (D5: 11.6 ± 6.2*10⁹/L vs. 14.5 ± 6.4*10⁹/L, p = 0.013; D7: 10.8 ± 5.9*10⁹/L vs. 14.1 ± 8.0*10⁹/L, p = 0.01), while the platelet counts were significantly lower in the linezolid group on Days 10 and 14 (D10: 219.2 ± 90.5*10⁹/L vs. 287.5 ± 100.4*10⁹/L, p = 0.049; D14: 263.0 ± 110.9*10⁹/L vs. 325.0 ± 155.1*10⁹/L, p = 0.036). For substantial haematologic abnormalities, there were no significant differences in leukopenia, neutropenia, agranulocytosis and thrombocytopenia between the two groups.
What Is New And Conclusions:
In VLBW infants, compared with vancomycin, linezolid tends to induce lower white blood cell and platelet counts transiently, but does not increase the severe forms of haematologic side effects.
