Resistance of gram-positive pathogens to antibiotics is a therapeutic challenge after liver transplantation: clinical experience in one center with linezolid.
BACKGROUND
Orthotopic liver transplantation has become an established therapeutic option for a large variety of fulminant and chronic liver diseases. Postoperative infections are the major cause of morbidity and the leading cause of mortality. The microbes responsible for these severe infections are predominantly gram-positive.


METHODS
This article reviews results of linezolid therapy based on the clinical characteristics, microbial features, and outcomes of severe bacterial infections due to known or suspected resistant gram-positive species in selected liver allograft recipients.


RESULTS
Among the 7 patients who received linezolid, methacillin-resistant Staphylococcus aureus. was isolated from 3, no pathogen from 2 patients, and serious pulmonary infection in 2 patients, 1 of whom had to be reintubated due to of respiratory failure. Cholangitis observed in 5 of 7 patients was caused by enterococci and staphylococci with septicemia in 1 subject. All patients demonstrated clinical improvement; microbiological eradication was observed in 4 patients. The majority of reported adverse events were mild or moderate in intensity. No potential drug interactions were observed between linezolid and concomitant medication.


CONCLUSIONS
In the present study, linezolid proved to be effective and well tolerated. In summary, linezolid may represent an effective and safe antimicrobial agent for the treatment of infections due to susceptible and resistant gram-postive bacteria after solid organ transplantation.
Odakowska-Jedynak
U
U
Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Poland.
Paczek
L
L
Krawczyk
M
M
Zieniewicz
K
K
Nyckowski
P
P
Pawlak
J
J
Patkowski
W
W
Skwarek
A
A
Paczkowska
A
A
D000081:Acetamides / Q000627:therapeutic use*; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D000069349:Linezolid; D016031:Liver Transplantation; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D023303:Oxazolidinones / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*
D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D000069349:Linezolid