title: Clinical experience with linezolid for the treatment of orthopaedic implant infections.
abstract: Gram-positive cocci are commonly isolated in orthopaedic implant infections and their resistance to β-lactams and fluoroquinolones is increasing. The high oral bioavailability of linezolid makes it an attractive oral alternative to glycopeptides and its use has increased in the last decade. To evaluate experience with linezolid in orthopaedic implant infections a systematic review of the literature available in English was undertaken. Only those articles describing series of ≥10 patients with acute or chronic orthopaedic implant infections treated with linezolid and with a clear definition of diagnosis and outcome were selected. A total of 293 patients (79.9% had prosthetic joint infections) were analysed in the 10 articles included. The overall remission rate with at least 3 months of follow-up was 79.9%, depending on whether the implant was removed or not (94% versus 69.9%). The addition of rifampicin was described in only two articles and no significant difference was observed. Adverse events were frequent during prolonged administration of linezolid (34.3%), requiring treatment discontinuation in 12.8%. The most common event was anaemia (13.4%) followed by gastrointestinal symptoms (11.1%). In conclusion, linezolid seems a good oral treatment alternative for orthopaedic implant infections due to Gram-positive cocci resistant to β-lactams and fluoroquinolones. However, close monitoring of adverse events is required.
authors.affiliation: Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, Villarroel 170, 08036 Barcelona, Spain lmorata@clinic.ub.es.
authors.forename: Laura
authors.initials: L
authors.lastname: Morata
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Hospital Clinic of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Tornero
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Hospital Clinic of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Martínez-Pastor
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Hospital Clinic of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Sebastián
authors.initials: S
authors.lastname: García-Ramiro
authors.affiliation: Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
authors.affiliation: Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Alex
authors.initials: A
authors.lastname: Soriano
mesh_terms: D000081:Acetamides / Q000009:adverse effects / Q000627:therapeutic use*; D000740:Anemia / Q000139:chemically induced / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000473:pathology; D005759:Gastroenteritis / Q000139:chemically induced / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D000069349:Linezolid; D010003:Osteoarthritis / Q000175:diagnosis / Q000628:therapy*; D023303:Oxazolidinones / Q000009:adverse effects / Q000627:therapeutic use*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D000069349:Linezolid
keywords: Gram-positive cocci; implant removal; orthopaedic surgery; prosthetic joint infection