Clinical Experience With Linezolid in Conjunction With Wound Coverage Techniques for Skin and Soft-Tissue Infections and Postoperative Osteomyelitis

Abstract

Gram-positive organisms are emerging as possibly the most important nosocomial pathogens during the past decade. Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infection in the postoperative patient. Burn victims are at high risk for developing vancomycin-resistant Enterococcus (VRE) and other multidrug-resistant microbial infections as a result of the immunocompromising effects of burn injury, prolonged intensive care unit stays, and broad-spectrum antibiotic therapy. To prevent serious and dreaded complications such as skin graft breakdown, delayed wound healing, loss of a limb, and even death, these infections require a combination of extensive antibiotic therapy and plastic surgical intervention. The objectives of this study were to report clinical experience with linezolid in addition to wound care, debridement, and wound coverage techniques for the treatment of S. aureus (including MRSA) and VRE infections. Forty patients received linezolid for infections of wound coverage such as an infected graft or flap, or received linezolid in conjunction with wound coverage techniques for a S. aureus or VRE infection. The median patient age was 53 years (range, 14-85 years), 55% were female, 28% of patients received intravenous (i.v.) linezolid only, 45% received i.v. with a switch to the oral formulation, and 28% received the oral formulation only. The clinical success rate of linezolid with adjuvant wound coverage techniques was 90.0% for osteomyelitis and was 100% for skin and soft-tissue infections. For infections of wound coverage, the clinical success rate was 83.3%. In conclusion, linezolid was an effective antibiotic for the treatment of S. aureus (including MRSA) and VRE infections in conjunction with wound coverage techniques. In addition, linezolid offers the option of treating these infections with an oral agent that is 100% bioavailable.

Implant stability in the treatment of MRSA bone implant infections with linezolid versus vancomycin in a rabbit model

“…In a compassionate‐use program conducted between 1997 and 2000, the clinical success rate in linezolid‐treated patients with osteomyelitis caused by MRSA or vancoymcin‐resistant enterococci was 90% with an average treatment duration of 40 days 23. In the same study, the therapeutic success rate for MRSA infections was 86.6%.…”

“…These data clearly indicate that orthopedic surgeons will continue to be confronted with MRSA infections of bone and implants. Without immediate initiation of adequate antimicrobial therapy, patients may suffer progressive bone destruction and death 23, 24. Therefore, it is crucially important to evaluate appropriate treatment options with regard to current standards of care, new agents, and older agents that may acquire a novel role in treatment.…”

Reactivation of dormant lumbar methicillin-resistant Staphylococcus aureus osteomyelitis after 12 years

“…The latter has the added benefit of having similar pharmacotherapeutic profiles for oral and intravenous preparations. 17 Rifampin is often added for its effectiveness against staphylococcus species; however, it is not recommended as monotherapy. 18 The initial enthusiasm generated by the fluoroquinolones for solitary use in the treatment of MRSA osteomyelitis has not persisted.…”

Linezolid versus Vancomycin for Prosthetic Joint Infections: a Cost Analysis

“…(1) The patient completed the primary antimicrobial treatment course and achieved clinical treatment success. Clinical success was defined as resolution of all the baseline clinical signs and symptoms of the infection [6]. (2) The patient completed the primary treatment course but did not achieve clinical treatment success.…”

“…A literature search on MEDLINE over the period of 1966-2005 was performed using keywords ''vancomycin'', ''linezolid'', ''orthopaedic infection'' and ''methicillin resistant''. Data from eight reports were included [6,[10][11][12][13][14][15][16]. The pooled averages of treatment success and treatment completion for each treatment option were derived from the studies weighted against the number of patients in each study.…”