Comparative analysis of lactic acidosis induced by linezolid and vancomycin therapy using cohort and case–control studies of incidence and associated risk factors

Abstract

This study indicates that LALA occurs more frequently than VALA does and is associated with renal insufficiency. Therefore, close monitoring of kidney function and serum lactate is recommended during LZD therapy.

The risk factors for linezolid-induced lactic acidosis in patients older than 85 years

“…Linezolid is a major tool in the treatment of MDR gram-positive pathogens and MDR-TB and can also cause type B lactic acidosis. We found that all patients showed different degrees of elevated lactate levels after using linezolid (1.2 [0.9,1.4] vs. 2.6 [1.8,3.7], p < 0.0001), and 35.7% had lactic acidosis; this percentage was higher than those in previous reports [17][18][19][20] . This may be because patients with mild disease were excluded due to the absence of blood gas monitoring, while the included patients had relatively severe disease, with multiple comorbid diseases in our study.…”

“…This may be because patients with mild disease were excluded due to the absence of blood gas monitoring, while the included patients had relatively severe disease, with multiple comorbid diseases in our study. In addition, patients who were not monitored for lactate in some previous studies were included in the non-lactic acidosis group, which led to the underestimation of LILA [20] .…”

“…In a retrospective study, a duration of linezolid therapy > 6 weeks was a risk factor for LILA [19] , but LILA has been reported to occur after a shorter duration of linezolid therapy (4 hours-7 days) [21,[25][26][27][28] and to occur even earlier in children, with a median time of 2 (1,13) days [29] . Del Pozo showed that the median duration of the administration of linezolid in lactic acidosis patients was 8 days [20] . We found that a duration of linezolid therapy ≥ 9 days was a risk factor for LILA in the super-elderly population, which suggested that LILA in the super-elderly population could occur after a short course of medication; therefore, the early and routine monitoring of lactate levels and blood gas is necessary.…”

“…A high SOFA score is also a risk factor for LILA, and the risk of lactic acidosis increased 0.429 times for every 1 point increase in the SOFA score, suggesting that super-elderly patients with high blood glucose or sequential organ failure are more prone to lactic acidosis. One study of 10 cases of LILA found that a SOFA score ≥ 11 and duration of linezolid therapy ≥ 7 days were not risk factors for LILA [20] . This was inconsistent with our results, which may be related to the univariate analysis employed in the other study.…”

“…The most common adverse reaction to linezolid is reversible myelosuppression (anaemia, thrombocytopenia, leukopenia) [9] , and some rare adverse reactions are toxic optic neuropathy [10,11] , irreversible peripheral neuropathy [12][13][14] and lactic acidosis [15,16] . The incidence of linezolidinduced lactic acidosis (LILA) has been reported to be between 5 and 33%, and it affects the survival of patients [17][18][19][20] .…”