Does linezolid protect against Clostridium difficile infection in major heart surgery patients?
Abstract number: P1472
Valerio M., Pedromingo M., Muñoz P., Marin M., Alcalá L., Bouza E.
Objectives:Clostridium difficile infection (CDI) is one of the main causes of diarrhea associated to antimicrobial therapy. Antibiotics with good "in vitro" activity against C. difficile, other than metronidazole or vancomycin, could be protective of CDI. One of these drugs is linezolid. We tried to assess the potentially protective role of linezolid in the development of CDI in patients receiving linezolid therapy for Ventilator Associated Pneumonia (VAP).
Methods: During a four year period, we retrospectively analyzed a cohort of patients who developed VAP after major heart surgery (MHS) in our institution. Patients were divided in those who developed CDI in the postoperative period and those who did not. We analyzed the charts in order to determine variables associated to the development of CDI including the role of antimicrobial therapy. We collected data involving pre-surgical, intraoperative and post-surgical variables. Treatment with Daily Defined Doses (DDD's) of linezolid and other antimicrobials were carefully registered. Univariate and multivariate analysis were performed. All statistical tests were two-tailed.
Results: Overall, 1844 patients had MHS. 105 cases had VAP, of which complete clinical data were available in 91 cases. CDI occurred in 22 (24.2%) patients. When comparing VAP cases with and without CDI, EUROSCORE and overall antibiotics prescribed were not significantly different. Patients with chronic renal failure were more prone to develop CDI than patients without it (32% vs. 13%; p = 0.04) and patients with CDI had received more doses of linezolid than dose without CDI (DDD's 12.4±9.7 vs 6.7±4.0; p = 0.007). A multivariate analysis confirmed that receiving more DDD's of linezolid protects against developing CDI (HR 0.908, p = 0.04, CI 95% 0.830.99).
Conclusion: Our study shows that VAP patients treated with more DDD's of linezolid therapy may have a lower occurrence of CDI. Our work has some limitations; it is retrospective, has a limited number of cases and addresses a very particular population but it is the first to suggest on clinical bases the potential impact of linezolid in protecting against CDI.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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