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Efficacy and tolerance of linezolid-rifampicin combination prolonged oral therapy for bone and joint infections

Abstract number: 1733_351

Senneville E., Legout L., Lemaire X., Dehecq C., Beltrand E., Loiez C., Migaud H., Yazdanpanah Y.

Objectives: To evaluate the efficacy and safety of linezolid-rifampicin combination (LRC) in the treatment of bone and joint infections.

Methods: The records for patients treated with LRC for more than 4 weeks because of chronic bone and joint infections were reviewed for clinical outcome and tolerance. Primary end points were the clinical outcome at follow-up after the end of treatment (F-EOT), and the occurrence of adverse effects.

Results: Between June 1999 and July 2005, 29 adult patients with 18 infected orthopaedic devices including 11 prosthetic joints, and 11 chronic osteomyelitis, were eligible for the study. Pathogens were predominantly methicillin-resistant staphylococci (16/30 strains, 53.3%). The mean treatment duration was 17.8±7.5 weeks. Patients were given intravenous therapy for 6–8 days as inpatients, and then, as outpatients, were changed to oral therapy with weekly haematological monitoring. Reversible anaemia (haemoglobin <90 g/L) was reported in 6 patients (20.7%), of whom 4 had to receive blood transfusions. Mean time from treatment initiation to anaemia onset was 7.5 weeks (range 4–11). No other LRC-related haematological toxicity episodes (i.e. leukopenia and thrombocytopenia) were recorded. Five patients (17.2%) had to stop the antibiotic treatment because of the occurrence of serious adverse effects (anaemia = 4, and peripheral neuropathy = 1). In the 10 patients who had two-stage exchange of prosthetic device, no linezolid-resistant strains grew from the samples taken during reimplantation of the prosthesis. At the end of treatment, 26 patients (89.6%) were cured. During the post-treatment follow-up (median duration: 17 months, range: 12–36), 1 patient experienced relapses of infection, resulting in an overall success rate of 25/29 (86.2%).

Conclusions: LRC prolonged oral therapy seems effective for treating patients with resistant Gram-positive cocci bone and joint infections, including infected orthopaedic devices. However, close haematological and neurological monitoring of patients receiving LRC prolonged therapy is needed in order to reduce the occurrence of severe adverse effects.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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