title: Clinical experience with linezolid for the treatment of neurosurgical infections.
abstract: OBJECTIVE
  We sought to evaluate the clinical use of linezolid for the treatment of neurosurgical infections.
  
  
  METHODS
  Retrospective observational study of a cohort of hospitalized patients who received linezolid for a culture-positive neurosurgical infection from July 2004 to February 2009 in a tertiary hospital in Spain.
  
  
  RESULTS
  Seventeen patients were included in the study. Main comorbidities among these patients included one or more of the following: subarachnoidal or intraventricular hemorrhage (n=8), solid neurological cancer (n=7), corticosteroids(n=9) and hydrocephalus (n=6). Eight patients underwent a craniotomy and fourteen patients had an external ventricular drainage (EVD) as predisposing factors for infection. Meningitis was the most common infection (11; 64.7%), followed by ventriculitis (4; 23.5%) and brain abscesses (2;11.8%). The main causative organisms were coagulase-negative Staphylococcus spp. (13; 76.5%). Linezolid was used as the initial therapy in 8 episodes, after therapy failure in 6 and for other reasons in 3. The oral route was used in 9 (52.9%) episodes; linezolid was initiated orally in 2 cases. The mean duration of treatment was 26.5 days (range 15-58). No adverse events were reported. Sixteen (94.1%) patients were considered cured.There was one recurrence. The mean length of hospital stay was 45.6 (range 15-112) days and the mean duration of follow-up was 7.2 (range 0.4-32) months. No related deaths occurred during active episodes.
  
  
  CONCLUSIONS
  Linezolid was mainly indicated in post-neurosurgical EVD-associated infections due to coagulase-negative Staphylococcus spp. It was used as initial therapy in most cases. A high rate of clinical cure was observed and no related adverse events were reported. More than half of the patients were benefited by the advantages of the oral route of administration.
authors.affiliation: Division of Infectious Diseases, Complejo Hospitalario Universitario A Coruña, Spain. dsoureg@sergas.es
authors.forename: D
authors.initials: D
authors.lastname: Sousa
authors.forename: P
authors.initials: P
authors.lastname: Llinares
authors.forename: H
authors.initials: H
authors.lastname: Meijide
authors.forename: J M
authors.initials: JM
authors.lastname: Gutiérrez
authors.forename: E
authors.initials: E
authors.lastname: Miguez
authors.forename: E
authors.initials: E
authors.lastname: Sánchez
authors.forename: L
authors.initials: L
authors.lastname: Castelo
authors.forename: A
authors.initials: A
authors.lastname: Mena
mesh_terms: D000081:Acetamides / Q000009:adverse effects / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D003399:Craniotomy; D005260:Female; D006801:Humans; D000069349:Linezolid; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D023303:Oxazolidinones / Q000009:adverse effects / Q000627:therapeutic use*; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D013030:Spain; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D000069349:Linezolid