my personal edition > bacterial infections > news


  E-Mail this DGReview to a colleague

DGReview

Linezolid May Be Useful Alternative For Treating Resistant Gram-Positive Bacteria

Linezolid may be an effective alternative to conventional antibiotics for treating endocarditis caused by resistant Staphylococcus epidermidis and possibly other gram-positive bacteria, according to a new case report.

The emergence of resistance to multiple antibiotics among gram-positive organisms has made the treatment of endocarditis challenging, the authors note. Linezolid is the first member of new antibiotic class, the oxazolidinones, and appears to be broadly active against gram-positive bacteria, including drug-resistant strains.

Vinod Ravindran, MD, with the Department of Cardiology, Castle Hill Hospital, East Yorkshire, Cottingham, United Kingdom, and colleagues report on a case of penicillin-resistant S. epidermidis endocarditis that failed to respond to a combination of intravenous gentamicin and flucloxacillin followed by flucloxacillin and rifampicin but was successfully treated with oral linezolid alone.

The patient was a 74-year-old woman with a history of mitral valve prolapse. In August 2001, she underwent laparotomy for obstructions resulting from intraperitoneal adhesions caused by a previous small bowel surgery in 1990.

During treatment, she had two ventricular tachycardia arrests, the treatment of which included placement of internal jugular lines on both occasions. The culture of the venous line tip once yielded S. epidermidis (August 2001) and blood cultures were positive for S. epidermidis twice (August and September 2001).

The patient was discharged in January 2002 but was readmitted in March 2002 due to complications. She became pyrexial 6 weeks later and blood cultures tested positive for S. epidermidis (sensitive to flucloxacillin, gentamicin, vancomycin, teicoplanin and rifampicin and resistant to penicillin and fusidic acid).

Because the patient did not respond to treatment with intravenous gentamicin and flucloxacillin or rifampicin and flucloxacillin, treatment with linezolid was started at a dose of 600 mg intravenous every 12 hours for three days and oral linezolid 600 mg every 12 hours thereafter.

"The response to treatment was dramatic and within a week she became apyrexial, white cell count normalised and repeat transthoracic echocardiogram demonstrated a significant decrease in the size of the vegetation," Dr. Ravindran and colleagues report. Furthermore, after 8 weeks, the patient was apyrexial, C-reactive protein was 4 mg/L, and blood cultures were negative for S. epidermidis.

According to the researchers, the linezolid therapy was extended to cover a mitral valve replacement operation, after which the culture of the mitral valve was negative for S. epidermidis.

"Unfortunately she died on the 6th postoperative day because of causes unrelated to the cardiovascular system," they note. However, "all four blood cultures done in the postoperative period were negative for any organisms," they point out.

The researchers conclude that "the successful use of oral linezolid alone in this lady with significant comorbid conditions demonstrates an effective alternative to the conventional antimicrobial therapy in such difficult cases."
J Infect 2003;47:2:164-166. "Successful use of oral linezolid as a single active agent in endocarditis unresponsive to conventional antibiotic therapy"

E-Mail this DGReview to a colleague

To print, use this version