Tolerability of prolonged linezolid-rifampicin combination in bone joint infection: a retrospective study
Abstract number: P824
Legout L., Lemaire X., N'guyen S., Dezeque H., Loez C., Caillaud M., Beltrand E., Migaud H., Dubreuil L., Yazdanpanah Y., Senneville E.
Background: High clinical success rate has been reported in patients (pts) treated with prolonged linezolid therapy (PLT) for bone joint infection (BJI) but bone marrow toxicity, especially anaemia, occurred in up to 25% of pts. Recently, a 35% decrease in the serum linezolid concentration was observed after the administration of 600 mg of rifampin due to a hypothetic increase in intestinal secretion of linezolid.
Objective: To assess whether linezolid-rifampicin combination (LRC) therapy reduces bone marrow toxicity compared with linezolid monotherapy or other linezolid combinations in patients with BJI.
Methods: Medical charts for pts with BJI treated with linezolid for at least 4 weeks were reviewed. Frequency of bone marrow toxicity events was assessed in pts treated with LRC and in those treated with linezolid monotherapy or other linezolid combinations. Anaemia was defined as haemoglobin value < 9.0g/dl, leukopenia as a total leucocyte count <4×109/L, and thrombocytopenia as a platelet count <100×109/L.
Results: 94 pts of mean age 53.5 ±17 years (range 1894) treated for BJI (devices infection = 37%, chronic osteomyelitis=33%) between 1999 and 2006 were eligible for the study. Comorbidities included diabetes mellitus (27.6%), alcoholism (9.6%) and chronic renal failure (6.4%). 43 pts (44.8%) were treated with LRC, 25 (26.6%) with linezolid monotherapy and, 28 (29.7%) with other linezolid combinations. Surgery was required in 75 pts (79.78%). Culture of intraoperative samples and bone biopsy (122 microorganisms) were positive in 91pts (96.8%) [(meticillin resistant Staphylococcus aureus: 38 (31%), coagulase negative staphylococci: 46 (37.7%), others Gram-positive bacteria: 21 (17.2%), Gram-negative bacilli: 12 (9.8%), anaerobes: 5 (4%)]. Polymicrobial infections were seen in 21 pts (22.34%). Demographic characteristics were comparable between pts treated with either LRC or other linezolid regimens. Anaemia was recorded in 5 of the 43 LRC pts (11.6%) and, in 22 of the 51 pts (43%) treated with other linezolid regimens (p= 0.001). The mean delay from onset of anaemia and initiation of linezolid therapy was 13.4 ±8.7 weeks in LRC pts and 9.5 ±4.3 weeks in the other pts (p = 0.001). 21/27 (77.8%) had to stop linezolid therapy and 15 of them had to be transfused. No other haematological adverse events were recorded.
Conclusion: PLT for BJI resulted in less anaemia episodes when it was combined with rifampin than when it was used in either monotherapy or other combinations.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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