title: Improving linezolid use decreases the incidence of resistance among Gram-positive microorganisms.
abstract: Surveillance studies have shown the emergence of infections with linezolid-resistant bacteria. The relationship between appropriate linezolid use and the spread of linezolid resistance among Gram-positive microorganisms in a single tertiary referral centre was evaluated. In an initial observational study, a prospective prescription-indication study was conducted on intensive care areas and haematology, neurosurgery, vascular surgery and nephrology wards during 2009. An intervention through follow-up feedback on audit results from May-June 2010 was then conducted. From July-December 2010, a second drug-use study of linezolid was conducted, with the same objectives and methodology. To assess the antimicrobial pressure of linezolid, an ecological study was conducted from 2006-2010 in the same hospital wards. Indications for linezolid in the initial study were considered suitable in 38.5% of cases, whilst in the second study the rate was 51.2% (33% increase). Linezolid consumption fell by 57% in the second half of 2010. A significant correlation was found between its inadequate use (DDD/1000 patient-days) and the incidence of linezolid-resistant strains/1000 patient-days (r=0.93; P=6.9e-024); 85% of the variability in the incidence of linezolid resistance was predicted by its inadequate use. Its partial correlations were significant for Enterococcus faecium (r=0.407; P=0.049), Staphylococcus epidermidis (r=0.874; P=2.3e-008) and Staphylococcus haemolyticus (r=0.406; P=0.049) but not Staphylococcus aureus (r=0.051; P=0.704). A relationship was found between appropriate linezolid use and the incidence of linezolid-resistant strains of E. faecium, S. epidermidis and S. haemolyticus.
authors.affiliation: Department of Clinical Pharmacology, Hospital La Paz Health Research Institute (IdiPAZ), School of Medicine, Universidad Autónoma de Madrid, Arzobispo Morcillo s/n, 28029 Madrid, Spain. elena.ramirez@uam.es
authors.forename: Elena
authors.initials: E
authors.lastname: Ramírez
authors.forename: Rosa
authors.initials: R
authors.lastname: Gómez-Gil
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Borobia
authors.forename: Francisco
authors.initials: F
authors.lastname: Moreno
authors.forename: Claudia
authors.initials: C
authors.lastname: Zegarra
authors.forename: Raúl
authors.initials: R
authors.lastname: Muñoz
authors.forename: Zaida
authors.initials: Z
authors.lastname: Reutero
authors.forename: Carolina
authors.initials: C
authors.lastname: de Montreuil
authors.forename: Diana
authors.initials: D
authors.lastname: González
authors.forename: Sonsoles
authors.initials: S
authors.lastname: Hernández
authors.forename: Alicia
authors.initials: A
authors.lastname: Herrero
authors.forename: Avelino
authors.initials: A
authors.lastname: Gutiérrez
authors.forename: Jesús
authors.initials: J
authors.lastname: Frías
mesh_terms: D000081:Acetamides / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000592:standards*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000592:standards*; D006094:Gram-Positive Bacteria / Q000187:drug effects*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D000069349:Linezolid; D016134:Organizational Policy; D023303:Oxazolidinones / Q000627:therapeutic use*; D011446:Prospective Studies; D062606:Tertiary Care Centers
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D000069349:Linezolid