Rev Esp Quimioter 2011:24(1):42-47

Clinical experience with linezolid for the treatment of neurosurgical infections  

D. SOUSA, P. LLINARES, H. MEIJIDE, J.M. GUTIÉRREZ, E. MIGUEZ, E. SÁNCHEZ, L. CASTELO, A. MENA      

 

Objectives: We sought to evaluate the clinical use of linezolid for the treatment of neurosurgical infections.
Methods: Retrospective observational study of a cohort of hospitalized patients who received linezolid for a culture-positive neurosurgical infection from July 2004 to February 2009 in a tertiary hospital in Spain.
Results: Seventeen patients were included in the study. Main comorbidities among these patients included one or more of the following: subarachnoidal or intraventricular hemorrhage (n=8), solid neurological cancer (n=7), corticosteroids(n=9) and hydrocephalus (n=6). Eight patients underwent acraniotomy and fourteen patients had an external ventriculardrainage (EVD) as predisposing factors for infection. Meningitis was the most common infection (11; 64.7%), followed by ventriculitis (4; 23.5%) and brain abscesses (2;11.8%). The main causative organisms were coagulase-negative Staphylococcus spp. (13; 76.5%). Linezolid was used as theinitial therapy in 8 episodes, after therapy failure in 6 and forother reasons in 3. The oral route was used in 9 (52.9%) episodes; linezolid was initiated orally in 2 cases. The mean duration of treatment was 26.5 days (range 15-58). No adverse events were reported. Sixteen (94.1%) patients were considered cured.There was one recurrence. The mean length of hospital stay was 45.6 (range 15-112) days and the mean duration of follow-up was 7.2 (range 0.4-32) months. No related deaths occurred during active episodes.
Conclusions: Linezolid was mainly indicated in post-neurosurgical EVD-associated infections due to coagulase-negative Staphylococcus spp. It was used as initial therapy in most cases. A high rate of clinical cure was observed and no related adverse events were reported. More than half of the patients were benefited by the advantages of the oral route of administration.    

 
Rev Esp Quimioter 2011:24(1):42-47 [pdf]

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Rev Esp Quimioter 2011:24(3):151-153

Usefulness of monitoring linezolid trough serum concentration in prolonged treatments      

R. SOUSA, R. LÓPEZ, J. C. MARTÍNEZ-PASTOR, C. CERVERA, G. BORI, S. GARCÍA-RAMIRO, J. MENSA, A. SORIANO           

 

Linezolid has proven valuable in musculoskeletal infections, however, failure and resistance have been described and toxicity is worrisome when more than 28 days are necessary. We describe the first 5 cases in whom linezolid trough serum concentrations were weekly measured and its relationship with clinical outcome and toxicity.
 

 
Rev Esp Quimioter 2011:24(3):151-153 [pdf]

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Rev Esp Quimioter 2011:24(2):57-66

Bacteraemia due to Escherichia coli producing extended-spectrum betalactamases (ESBL): clinical relevance and today’s insights  

A. M. GARCÍA-HERNÁNDEZ, E. GARCÍA-VÁZQUEZ, A. HERNÁNDEZ-TORRES, J. RUIZ, G. YAGÜE, J. A. HERRERO, J. GÓMEZ     

 

Antibiotic resistance is an old problem with new face as the rate of infections due to multidrug resistant bacteria is higher everyday and the number of new antibiotics to overwhelm the problem is becoming smaller. E. coli is the most frequent agent causing nosocomial or community-acquired bacteraemia being in our country 10% of them extended-spectrum betalactamases (ESBL) producing E. coli isolates. Nowadays the number of community- acquired or health-related infections caused by these ESBL producing E. coli is increasing. CTX-M has also become the most frequent ESBL compared to other enzymes. The role of these enzymes as a virulence factor increasing mortality in patients with bacteraemia due to E. coli is not well defined. The relevance of ESBL-E. coli seems to be related with the higher frequency of inadequate treatment and therefore the importance of identifying factors or features that might predict that the patient’s infection is due to one of these isolates. In terms of prevention and control of infection measures, the role of patient’s isolation is not clear but a proper prescription of antibiotics and antibiotic control policies are probably important to reduce the problem.    

 
Rev Esp Quimioter 2011:24(2):57-66 [pdf]

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Rev Esp Quimioter 2011:24(3):154-163

Pharmacoeconomic assessment of daptomycin as first-line therapy for bacteraemia and complicated skin and skin structure infections caused by gram-positive pathogens in Spain      


S. GRAU, P. REBOLLO, J. CUERVO, S. GIL-PARRADO            

Objective: To assess the efficiency of daptomycin as firstline therapy (D) versus daptomycin as salvage therapy after vancomycin (V→D ) or linezolid (L→D) failure in gram-positive bacteraemia and complicated skin and skin-structure infections (cSSTIs).
Methods: Cost-effectiveness analysis of 161 bacteraemia and 84 cSSTIs patients comparing the above mentioned therapeutic alternatives was performed using the data from 27 Spanish hospitals involved in the EUCORE study. Direct medical costs were considered. Patients were observed from the first antibiotic dose for infection until either the end of daptomycin therapy or exitus. A multivariate Monte Carlo probabilistic sensitivity analysis was applied for costs (lognormal distribution) and effectiveness (normal distribution).
Results: In terms of effectiveness there were no statistical differences between groups but referring total costs per patient, there were significant differences. Sensitivity analysis confirmed that D dominates over L→D between 44.2%-62.1% of simulations in bacteraemia and between 48.2%-67.5% in cSSTIs. In comparison to V→D, D dominance was detected in 29.2%-33.2% of simulations in bacteraemia and between 48.2%-59.3% in cSSTIs.
Conclusions: Daptomycin as first-line therapy dominates over daptomycin as salvage therapy after linezolid failure both in bacteraemia and cSSTIs. Comparing daptomycin as first-line therapy with its use after vancomycin failure, in cSSTIs the former is dominant. In bacteremia daptomycin as first line therapy is as effective as daptomycin as salvage therapy after vancomycin failure and implies lower costs. 

 
Rev Esp Quimioter 2011:24(3):154-163 [pdf]

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