Assessment of linezolid prescriptions in three French hospitals

Abstract

The use of linezolid to treat gram-positive cocci infections is increasing in France. Linezolid is approved in pneumonia and complicated skin and soft tissue infections. Overuse and misuse of linezolid can favor the emergence and spreading of linezolid-resistant strains. We aimed to assess the appropriateness of linezolid use in French hospitals. This is a multicenter, retrospective study conducted in three tertiary care hospitals. Appropriateness of linezolid indications and adequacy (composite score concerning dosage, route of administration and blood monitoring) were assessed. Over a three-month period, all prescriptions of linezolid were extracted and analyzed by two independent infectious disease experts. Among the 81 initial prescriptions that were evaluated, indication was appropriate in 48% of cases. Among those, 51% complied with international guidelines. Fifty-seven percent of the prescriptions were adequate regarding dosage, route of administration and blood monitoring. Overall, 23% of prescriptions combined both appropriateness and adequacy. The most frequent reasons for inappropriateness were the possibility of choosing narrower-spectrum antibiotics and the empirical use of linezolid in severe sepsis or septic shock. Initial treatment was the most frequently appropriate in bone and joint infection cases (p = 0.001). Our study shows that even if modalities of use were mostly correct, appropriateness of linezolid indications is low. Educational programs are mandatory to improve practices, as well as clinical studies to better assess the efficacy and safety of linezolid in clinical situations other than pneumonia or complicated skin and soft tissue infections.

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

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Composite measures of quality of health care: Evidence mapping of methodology and reporting

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Barriers and Facilitators to Implementation of Antibiotic Stewardship Programmes in Hospitals in Developed Countries: Insights From Transnational Studies

“…In practice, ASP initiatives are a heterogeneous group of system-and organization-based strategies and actions (Dyar et al, 2017), and countries and organizations may vary greatly in their capacity to deploy the necessary resources to implement those interventions (Tiong et al, 2016). For example, there is substantial transnational and even national variability in appropriate prescribing and compliance with antibiotic guidelines (Sandora et al, 2016;Turnidge et al, 2016;Dentan et al, 2017;Mousavi et al, 2017). The international research community faces the challenge of optimizing implementation initiatives, such as ASPs, by producing generalisable evidence that incorporates relevant theory and an understanding of the contextual influences (Ivers and Grimshaw, 2016).…”