Successful Treatment with Linezolid in Two Cases of Methicillin-Resistant Staphylococcus aureus Infections in the Orthopedic Field

Abstract

We have reported two orthopedic patients with Methicillin-resistant Staphylococcus aureus (MRSA) infections successfully treated with linezolid. The first case was a 64-years-old man with bacteremia, spondylitis and psoas abscesses caused by MRSA. He was treated with arbekacin (ABK) and vancomycin (VCM), and then became afebrile. However he complained of a recurrence of fever and oliguria, we administered linezolid for two weeks intravenously because of fluctuating renal dysfunction. Thereafter his clinical conditions improved. The second case was a 26-years-old man with MRSA infection of the pelvis after a trauma. He was treated with teicoplanin (TEIC) for two weeks. However the minimum inhibiratory concentrations (MICs) of TEIC and VCM against MRSA, isolated from the wounds, were 4 micrograms/ml each, we administered linezolid intravenously and the patient was successfully treated in four weeks. Linezolid has been proven to have high efficacy against MRSA by some trials abroad. But the agent has the indication only for VRE by the Medical Insurance in Japan. These cases also suggest that linezolid is useful for MRSA infections in these cases.

Linezolid for the treatment of adults with bone and joint infections

“…A summary of the relevant case reports is shown in Table 1 [12][13][14][15][16]. Only a few case reports are available in the literature; all patients received 600 mg of linezolid twice daily and all patients were successfully treated.…”

“…The use of linezolid was considered only if administration of other antibiotics was not indicated as a result of treatment failure with other antibiotics to which the isolated cocci were susceptible, isolation of bacteria resistant to vancomycin or allergic reactions to other antibiotics. Patients treated for osteomyelitis [12,13,16] and prosthetic joint infections [12,14,15] are mainly reported.…”

Role of linezolid in the treatment of orthopedic infections

“…Though controlled clinical trials specifically investigating the safety and efficacy of linezolid in orthopedic infections have not been carried out, various case reports have documented successful treatment of resistant infections in orthopedic practice. These include infected joint prostheses [78][79][80][81], osteomyelitis [78,[81][82][83] and bone infection following trauma [83]. The results of the cure rates in skin, soft-tissue and bone infections reported in randomized and nonrandomized trials are detailed in TABLES 2 & 3.…”

Treatment with linezolid and rifampicin for 18 months for recurrent infection of a megaprosthesis in a patient with Ewing's sarcoma

“…[13,14] [1 month, 56 days, respectively] or in patients refusing further surgical procedures as antibiotic therapy only [15]. Furthermore, one successful treatment of MRSA spondylitis [for 2 weeks] [16] and one of VRE and MRSA vertebral osteomyelitis [of 6 weeks] combined with surgical debridement [10] have been reported. Side effects such as myelodepression have not been observed, but since the clinical studies have been over 2 weeks to 60 days only, no evidence about long-term toxicity could be given in these cases.…”