Antimicrobial stewardship and linezolid

Guillard, Pauline; Blanchardière, A. de La; Cattoir, Vincent; Fischer, Marc-Olivier; Verdon, Renaud; Saint-Lorant, Guillaume

doi:10.1007/s11096-014-9995-9

Cited by 9 publications

(7 citation statements)

References 18 publications

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“…But this observation doesn’t justify the use of this antibiotic without specifying the indication and in the absence of microbiological documentation. In the study of Guillard and al, 45% of prescriptions were outside the MA criteria which is almost of product to the results of our study [ 22 ]. However, other studies have shown different results such as the study of Aubin and al at the University Hospital of Nantes (61.1%) and of Angers (71.5%) [ 23 ].…”

Section: Discussionsupporting

confidence: 87%

Proper use of antibiotics: situation of linezolid at the intensive care unit of the Tunisian Military Hospital

Safa¹,

Afif²,

Hajjej³

et al. 2016

Pan Afr Med J

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Linezolid was introduced in clinical practice in the early 2000s. It was considered to be an ideal reserve drug for treatment of vancomycin-resistant Enterococcus spp. (VRE) and vancomycin-resistant Staphylococcus aureus (VRSA). The aim of our study was to describe and evaluate the use of linezolid in clinical practice at the intensive care unit (ICU) of the Tunisian military hospital. This is a thirty-month retrospective study including patients treated with linezolid at the ICU of the Tunisian military hospital. Data collection was realized using the patients’ medical files and prescriptions. A pharmacist conducted an extended medication history and checked if an advice from an infectious disease-physician and a microbiological documentation were requested. A total of 80 patients were included. Forty-one per cent of indications were outside the Marketing Authorization (MA) criteria, and were mainly sepsis and postoperative mediastinitis (32% and 4% of total prescriptions, respectively). This antibiotic was used as a first-line therapy in 58% of cases. The advice from an infectious-disease physician was requested for 33% of prescriptions. Only 20% of infections were documented microbiologically, of which 35% were caused by methicillin resistant coagulase-negative Staphylococcus. Linezolid is an interesting therapeutic alternative in case of infections due to multi-resistant bacteria and/or complex clinical situations. Therefore, its prescription must be rationalized in order to slow down the emergence of resistance to this antibiotic. The high frequency of its use outside the MA criteria shows the importance of carrying out more clinical trials to evaluate its effectiveness and safety for new indications.

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Section: Discussionsupporting

confidence: 87%

Proper use of antibiotics: situation of linezolid at the intensive care unit of the Tunisian Military Hospital

Safa¹,

Afif²,

Hajjej³

et al. 2016

Pan Afr Med J

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“…As an example, a French study assessing the appropriateness of linezolid prescriptions in three hospitals found that, among 81 treatments, 65% were considered off-label regarding the indications [ 30 ]. A second study performed in a single French hospital recorded an off-label use of 45% between 2009 and 2013 [ 21 ]. A similar proportion (40%) was described in a monocentric Spanish study [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most frequently reported risk factors, especially for thrombocytopenia, are a long treatment duration [ 14 ], a bad renal function [ 15 , 16 ], and a low body weight [ 17 , 18 ]. In spite of these drawbacks, off-label use of linezolid is quite common [ 19 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Use and Adverse Drug Reactions of Linezolid: A Retrospective Study in Four Belgian Hospital Centers

et al. 2021

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In Belgium, linezolid is indicated for pneumonia and skin and soft tissue infections, but is more broadly used, due to its oral bioavailability and activity against multiresistant organisms. This could increase the risk of adverse drug reactions (ADR), notably hematological disorders (anemia, thrombocytopenia), neuropathy, or lactic acidosis. We analyzed linezolid clinical use in relationship with occurrence of ADR in Belgian hospitals and highlighted risk factors associated with the development of thrombocytopenia. A retrospective analysis of electronic medical records and laboratory tests of adult patients treated with linezolid in four Belgian hospitals in 2016 allowed the collection of ADR for 248 linezolid treatments. Only 19.7% of indications were in-label. ADR included 43 thrombocytopenia, 17 anemia, 4 neuropathies, and 4 increases in lactatemia. In a multi-variate analysis, risk factors of thrombocytopenia were a treatment duration > 10 days, a glomerular filtration rate < 60 mL/min, and a Charlson index ≥ 4. Off-label use of linezolid is frequent in Belgium, and ADR more frequent than reported in the summary of product characteristics, but not statistically associated with any indication. This high prevalence of ADR could be related to a high proportion of patients presenting risk factors in our population, highlighting the importance of detecting them prospectively.

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“…However, patients in surgical non-ICU wards were the second most common patient group to receive linezolid in 2016. In this patient group, off-label use of linezolid appears likely [32]. Recommendations by the Surgical Infection Society and the Infectious Diseases Society of America include linezolid as an option in the treatment of complicated intraabdominal infections [33].…”

Section: Discussionmentioning

confidence: 99%

Linezolid use in German acute care hospitals: results from two consecutive national point prevalence surveys

Kramer

Schwab

Behnke

et al. 2019

Antimicrob Resist Infect Control

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BackgroundLinezolid belongs to a reserve group of antibiotics. In recent years, reports on linezolid resistance in gram-positive cocci have become more frequent. Overuse of linezolid is a relevant factor for resistance development. The objective of this study was to describe current prescription practices of linezolid in German hospitals and identify targets for antimicrobial stewardship interventions.MethodsWe analyzed all linezolid prescriptions from the datasets of the consecutive national point prevalence surveys performed in German hospitals in 2011 and 2016. In both surveys, data on healthcare-associated infections and antimicrobial use were collected following the methodology of the European Centre for Disease Prevention and Control.ResultsOverall, the percentage of linezolid among all documented antimicrobials increased significantly from 2011 to 2016 (p < 0.01). In 2011, 0.3% (119 of 41,539) patients received linezolid, in 2016 this proportion was significantly higher (0.4%; 255 of 64,412 patients; p < 0.01). In 2016, intensive care units (ICUs) were the wards most frequently prescribing linezolid. The largest proportion of patients receiving linezolid were non-ICU patients. Roughly 38% of linezolid prescriptions were for treatment of skin/soft tissue and respiratory tract infections. In 2016, linezolid was administered parenterally in 70% (n = 179) of cases. Multivariable analysis showed that the ward specialty ICU posed an independent risk factor, while Northern and Southwestern regions in Germany were independent protective factors for a high rate of linezolid prescriptions.ConclusionsIn conclusion, we detected potentials for improving linezolid prescription practices in German hospitals. Given the emergence of linezolid resistance, optimization of linezolid use must be a target of future antimicrobial stewardship activities.

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Antimicrobial stewardship and linezolid

Cited by 9 publications

References 18 publications

Proper use of antibiotics: situation of linezolid at the intensive care unit of the Tunisian Military Hospital

Proper use of antibiotics: situation of linezolid at the intensive care unit of the Tunisian Military Hospital

Clinical Use and Adverse Drug Reactions of Linezolid: A Retrospective Study in Four Belgian Hospital Centers

Linezolid use in German acute care hospitals: results from two consecutive national point prevalence surveys

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