Risk factors for anaemia in patients on prolonged linezolid therapy for chronic osteomyelitis: a case-control study.
OBJECTIVE
The intrinsic properties of the new antibiotic linezolid make it an attractive candidate for the treatment of chronic osteomyelitis. However, data regarding the tolerance of long-term linezolid administration are still lacking.


METHODS
The medical charts of patients given linezolid for >4 weeks were retrospectively analysed, especially their haematology. In a case-control study, we compared the respective characteristics of patients who developed anaemia during linezolid therapy and those who did not.


RESULTS
Forty-five adults with chronic osteomyelitis received 600 mg linezolid intravenously twice daily for 7 days, and then orally, for a mean total duration of 15.9 weeks (range, 6-36). Anaemia episodes requiring blood transfusion occurred in 13/45 patients (28.9%). Median time from treatment initiation to anaemia onset was 7.4 weeks (range, 4-16). Anaemia was significantly associated with premature linezolid therapy cessation (P = 0.0012). No linezolid-related thrombocytopenia was observed. By univariate analysis, four variables were associated with the occurrence of anaemia: age >58 years, alcohol abuse, diabetes mellitus and low haemoglobin before linezolid treatment. Logistic regression analysis revealed two independent risk factors for anaemia: age >58 years (OR = 20.5, 95% CI 0.69-599; P = 0.0001) and pre-treatment haemoglobin <10.5 g/dL (OR = 16.49, 95% CI 1.06-255; P = 0.04).


CONCLUSIONS
Profound anaemia may occur in adult patients with chronic osteomyelitis on prolonged linezolid therapy, and often necessitates linezolid cessation. These patients are likely to be aged >58 years and to have low pre-treatment haemoglobin. The results for the present series might help physicians to identify patients who should not be given long-term linezolid treatment for chronic osteomyelitis.
Senneville
Eric
E
Infectious Diseases Department, Dron Hospital, 135 rue du Président Coty, 59200 Tourcoing, France. esenneville@ch-tourcoing.fr
Legout
Laurence
L
Valette
Michel
M
Yazdanpanah
Yazdan
Y
Giraud
François
F
Beltrand
Eric
E
Obert
Guillaume
G
Dubreuil
Luc
L
Migaud
Henri
H
Mouton
Yves
Y
D000081:Acetamides / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000139:chemically induced*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D016022:Case-Control Studies; D002908:Chronic Disease; D004334:Drug Administration Schedule; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D007275:Injections, Intravenous; D000069349:Linezolid; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy*; D023303:Oxazolidinones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors
D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D000069349:Linezolid