Early switch from vancomycin to oral linezolid for treatment of gram-positive heart valve endocarditis.
BACKGROUND
Patients with complicated gram-positive endocarditis are usually treated with a combination of surgical procedure and long-term antibiotic therapy with intravenous vancomycin. However, oral linezolid offers the potential for an early switch from intravenous vancomycin to oral linezolid therapy.


METHODS
We conducted a retrospective study from February 2002 to August 2005 to determine the potential for early switch from intravenous vancomycin to oral linezolid in patients surgically treated for a left-sided active gram-positive endocarditis.


RESULTS
Fourteen patients were identified; average age was 52 +/- 16 years. There were 10 (85%) and 2 (15%) cases of native and prosthetic valve endocarditis, respectively. Patients were operated on 3 to 10 days after diagnosis. There were no cases of operative mortality. Mean follow-up was 20.8 +/- 7.0 months. Two (14%) patients died of noncardiac causes during follow-up. The mean intensive care unit length of stay was 3.1 +/- 2.3 days, and mean hospital length of stay was 10.5 +/- 3.4 days. No cases of recurrent endocarditis or periprosthetic leakage were observed.


CONCLUSIONS
The combination of aggressive surgical treatment and the early switch from intravenous vancomycin to oral linezolid for treatment of active gram-positive heart valve endocarditis is safe and effective, and reduces infection relapses, vancomycin use, hospital length of stay, and economic costs.
Colli
Andrea
A
Department of Cardiac Surgery, University of Parma, Parma, Italy. colli.andrea@libero.it
Campodonico
Riccardo
R
Gherli
Tiziano
T
D000081:Acetamides / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004697:Endocarditis, Bacterial / Q000188:drug therapy*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D017048:Health Care Costs; D006349:Heart Valve Diseases / Q000188:drug therapy*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D000069349:Linezolid; D008297:Male; D008875:Middle Aged; D023303:Oxazolidinones / Q000627:therapeutic use*; D012189:Retrospective Studies; D014640:Vancomycin / Q000627:therapeutic use*
D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid