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Linezolid Therapy for Orthopedic Infections

      OBJECTIVE

      To assess the clinical and bacteriological efficacy and the safety and tolerability profile of linezolid when used as the primary component of a combined surgical and antimicrobial treatment strategy for orthopedic infections.

      PATIENTS AND METHODS

      We retrospectively reviewed medical records to obtain clinical, bacteriological, and safety outcomes of 20 consecutive patients who took linezolid for the treatment of orthopedic infections between April 1, 2000, and November 30, 2002.

      RESULTS

      Twenty patients received linezolid therapy for microbiologically confirmed orthopedic infections due to gram-positive cocci during the 32-month study period. Fifteen patients (75%) had infections involving orthopedic hardware; in 10 of these patients, the hardware was removed. All 20 patients underwent surgical débridement. At a mean follow-up of 276 days, 11 patients (55%) achieved clinical cure, 7 (35%) had clinical improvement but received long-term antimicrobial suppressive therapy, 1 (5%) had clinical relapse after discontinuing linezolid treatment, and 1 (5%) died of a cause unrelated to linezolid treatment. Bacterial persistence was documented in 3 patients (15%), all of whom were infected with methicillin-resistant Staphylococcus aureus. Eight patients (40%) developed reversible myelosuppression, 1 (5%) had irreversible peripheral neuropathy, and 2 (10%) discontinued linezolid treatment because of pancytopenia or urticaria.

      CONCLUSION

      Oral linezolid may be an effective alternative therapy for orthopedic infections due to linezolid-susceptible gram-positive bacteria in patients who are unable to take other antimicrobial drugs because of drug allergy or intolerance or antimicrobial resistance.
      MRSA (methicillin-resistant Staphylococcus aureus), MRSCN (methicillin-resistant coagulase-negative staphylococcus), VRE (vancomycinresistant enterococcus), WBC (white blood cell)
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