Increasing use of linezolid in a tertiary NICU during a 10-year period: reasons and concerns for the future

Abstract

Background Linezolid has been increasingly used in tertiary NICUs. The objectives of this study were to explore the indications of these linezolid prescriptions, to analyze a possible misuse and to provide solutions to avoid such misuse. Methods A monocentric retrospective cohort study included all neonates hospitalized in one tertiary NICU between January 1st, 2010 and December 31st, 2019 and who received at least one administration of linezolid. These data were confronted to epidemiological and antibiotic use data from the same NICU. Two independent pediatricians secondarily classified linezolid uses as adequate or not. Results During the study period, 66 infections in 57 patients led to linezolid use. Most patients were pre-term and 21 patients (37%) died. Infections were mainly related to methicillin-resistant coagulase negative staphylococci and were frequently either pneumoniae (35%) or isolated bacteremia (48%), including 25 persistent bacteremia (64% of the 39 bacteremia). Need for a better tissue distribution or first-line treatment failure were the main reasons to initiate linezolid. Linezolid was administered for a median duration of 7 [3;10] days. No side effects were reported. Twenty-two (33%) of the 66 linezolid prescriptions were retrospectively classified as inadequate. Conclusions A rapid increase in linezolid prescriptions has been observed in our tertiary NICU, from 2014 to 2019, with 33% inadequate uses. This worrisome trend should lead to search for therapeutic alternatives and to work on antibiotic stewardship to prevent the emergence of new antimicrobial bacterial resistance.

Update on Coagulase-Negative Staphylococci—What the Clinician Should Know

“…Currently, only limited data is available to recommend its use in CoNS as a first-line treatment. Still, there have been increasing reports on linezolid use in the past years [ 87 , 88 ]. In a large study on the feasibility of early oral step-down therapy in endocarditis, linezolid was among the antibiotics that were used, and was largely used in combination with other antibiotics [ 89 ].…”

Bacterial Profile and Antibiogram of Microorganisms Isolated From Different Body Site Infections Among Patients of a Private Hospital, Karachi

“…These results show a slight contrast in susceptibility in vancomycin and linezolid in study carried out in China, this may be a red flag for clinician's specially managing critically ill patients [16]. Oral availability of linezolid is one of the factors observed contributing to its resistance observed in study conducted in France [17] although our data exhibits 100 % sensitivity against linezolid. Carbapenem resistance is one of the striking observations in our study, which is so alarming in the era of developing antibiotic resistance.…”

Neonatal bloodstream infections

“…Finally, vancomycin-resistant enterococci remain a rare but persistent threat in nurseries [24]. This trend has driven increased interest in the pharmacokinetics and pharmacodynamics of alternative antibiotics with activity against grampositives, including linezolid, daptomycin, and ceftaroline [21,[25][26][27].…”