title: Experience with linezolid for the treatment of nocardiosis in organ transplant recipients.
abstract: OBJECTIVE
  Combination therapy with amikacin is recommended for treatment of nocardiosis in severely ill solid organ transplant recipients (SOT), but its use is complicated by nephrotoxicity. Linezolid has shown promise as an alternative in the empiric therapy of nocardiosis, but little is known about its effectiveness and safety in this setting. We describe the experience with linezolid for nocardiosis in SOT.
  
  
  METHODS
  Retrospective review of cases of nocardiosis in SOT at a large center from 2006 to 2012.
  
  
  RESULTS
  Nineteen cases were identified, 15/19 in lung transplant recipients. Median creatinine clearance at diagnosis was 56 ml/min. Eighteen patients were treated: 17/18 (94%) received trimethoprim/sulfamethoxazole and 15/18 (83%) received linezolid. Median duration of linezolid treatment was 21 days and it was discontinued in 10/15 (67%) due to side effects. Thrombocytopenia and anemia occurred in 14/15 (93%) and 9/15 (60%) of patients on linezolid, respectively, and were not different from patients not on linezolid. Cure was observed in 16/19 (84%), 33% of deaths were related to nocardiosis.
  
  
  CONCLUSIONS
  Linezolid was acceptable as initial empiric therapy for nocardiosis. Myelosuppression was a limiting factor, but not exclusive to patients on linezolid and could have been aggravated by concomitant use of other myelosuppressive drugs.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, 3601 5th Avenue Suite 3A, Pittsburgh, PA 15213, USA.
authors.forename: Oveimar
authors.initials: O
authors.lastname: De La Cruz
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, 3601 5th Avenue Suite 3A, Pittsburgh, PA 15213, USA.
authors.forename: Lucio R
authors.initials: LR
authors.lastname: Minces
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, 3601 5th Avenue Suite 3A, Pittsburgh, PA 15213, USA; University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA. Electronic address: silveirafd@upmc.edu.
authors.forename: Fernanda P
authors.initials: FP
authors.lastname: Silveira
mesh_terms: D000081:Acetamides / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000494:pharmacology*; D005260:Female; D006801:Humans; D000069349:Linezolid; D016040:Lung Transplantation; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009615:Nocardia / Q000302:isolation & purification; D009617:Nocardia Infections / Q000175:diagnosis / Q000188:drug therapy*; D016377:Organ Transplantation; D023303:Oxazolidinones / Q000494:pharmacology*; D010414:Pennsylvania; D012189:Retrospective Studies; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology
chemical_list: D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000069349:Linezolid
keywords: Linezolid; Nocardiosis; Organ transplant; Recipient infection