<i>Nocardia</i> spp. Pneumonia in a Solid Organ Recipient: Role of Linezolid

Mwandia, George; Polenakovik, Hari

doi:10.1155/2018/1749691

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…The mean duration of linezolid therapy was 21 days. 131 The long-term toxicity associated with linezolid includes anemia, 251,252 thrombocytopenia, 252 optic neuropathy, 253 and peripheral neuropathy, [254][255][256] which can be severe and irreversible. Hence, the use of linezolid has been somewhat limited due to high cost and side effects, but has exceptional activity in vitro and efficacy has been impressive in some clinical series.…”

Section: Antimicrobial Susceptibilitymentioning

confidence: 99%

Nocardia spp.: A Rare Cause of Pneumonia Globally

Lynch

Reid

Clark

2020

Semin Respir Crit Care Med

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AbstractMembers of the Nocardia genus are ubiquitous in the environment. These aerobic, gram-positive organisms can lead to life-threatening infection, typically in immunocompromised hosts such as solid organ transplant recipients or those receiving immunosuppressive medications for other reasons. This current review discusses the microbiology of nocardiosis, risk factors for infection, clinical manifestations, methods for diagnosis, and treatment. Nocardiosis primarily affects the lung but may also cause skin and soft tissue infection, cerebral abscess, bloodstream infection, or infection involving other organs. Although rare as a cause of community-acquired pneumonia, Nocardia can have severe morbidity and mortality, particularly in patients with comorbidities or compromised immunity. Early diagnosis and timely initiation of therapy are critical to optimizing patient outcomes. Species identification is important in determining treatment, as is in vitro susceptibility testing. Sulfonamide therapy is usually indicated, although a variety of other antimicrobials may be useful, depending on the species and susceptibility testing. Prolonged therapy is usually indicated, for 6 to 12 months, and in some cases surgical debridement may be required to resolve infection.

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Section: Antimicrobial Susceptibilitymentioning

confidence: 99%

Nocardia spp.: A Rare Cause of Pneumonia Globally

Lynch

Reid

Clark

2020

Semin Respir Crit Care Med

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Safety and Outcomes of Linezolid Use for Nocardiosis

Davidson

Grigg

McGuinness

et al. 2020

Open Forum Infectious Diseases

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Background Tropical Australia has a high incidence of nocardiosis, with high rates of intrinsic antimicrobial resistance. Linezolid, the only antimicrobial to which all local Nocardia species are susceptible, has been recommended in empirical combination treatment regimens for moderate–severe Nocardia infections at Royal Darwin Hospital (RDH) since 2014. We report the safety and efficacy of linezolid use for nocardiosis in this setting. Methods We identified cases through a retrospective review of all RDH Nocardia isolates from December 2014 to August 2018 and included 5 linezolid-treated cases from a previous cohort. Laboratory, demographic, and clinical data were included in the primary analysis of safety and treatment outcomes. Results Between 2014 and 2018, Nocardia was isolated from 35 individuals; 28 (80%) had clinically significant infection and 23 (82%) received treatment. All isolates were linezolid-susceptible. Safety and efficacy were assessed for 20 patients receiving linezolid-containing regimens and 8 receiving nonlinezolid regimens. Median linezolid induction therapy duration was 28 days. Common adverse effects in those receiving linezolid were thrombocytopenia (45%) and anemia (40%). Adverse events prompted discontinuation of trimethoprim-sulfamethoxazole more often than linezolid (40% vs 20%). Linezolid therapeutic drug monitoring was used in 1 patient, with successful dose reduction and outcome. There was no difference in 30-day survival between those treated with linezolid (90%) vs no linezolid (87%). One Nocardia-attributed death occurred during linezolid therapy. Conclusions Linezolid is safe and efficacious in empirical treatment for moderate to severe nocardiosis in a monitored hospital setting, with 100% drug susceptibility and no difference in adverse events or outcomes compared with nonlinezolid regimens.

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Nocardia spp. Pneumonia in a Solid Organ Recipient: Role of Linezolid

Cited by 2 publications

References 15 publications

Nocardia spp.: A Rare Cause of Pneumonia Globally

Nocardia spp.: A Rare Cause of Pneumonia Globally

Safety and Outcomes of Linezolid Use for Nocardiosis

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