title: Linezolid bladder irrigation as adjunctive treatment for a vancomycin-resistant Enterococcus faecium catheter-associated urinary tract infection.
abstract: OBJECTIVE
  To describe the first reported successful use of adjunctive linezolid bladder irrigation.
  
  
  METHODS
  An 89-year-old woman with 10% TBSA burns developed septic shock and anuric acute kidney insufficiency. She acquired a urinary tract infection caused by vancomycin-resistant Enterococcus faecium (VREfm). Based on clinical status, a linezolid bladder irrigation was initiated in addition to high-dose intravenous linezolid and demonstrated microbiological cure with 7 days of treatment.
  
  
  CONCLUSIONS
  Linezolid is primarily hepatically cleared and has no labeled indication for urinary tract infections. Anuria adds an additional complication of potentially reduced urinary drug concentrations. Bladder irrigation offers the benefit of achieving high local drug concentrations, but there are no data regarding such a route for linezolid. This case report is the first demonstrating the use, stability, safety, and efficacy of linezolid as a continuous bladder irrigation.
  
  
  CONCLUSIONS
  Linezolid use as a bladder irrigation may be a feasible route of administration in anuric, critically ill patients with VREfm and few antimicrobial options. Further studies are warranted.
authors.affiliation: Regional One Health, Memphis, TN, USA dmhill@regionalonehealth.org.
authors.forename: David M
authors.initials: DM
authors.lastname: Hill
authors.affiliation: University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA.
authors.forename: G Christopher
authors.initials: GC
authors.lastname: Wood
authors.affiliation: University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA.
authors.forename: William L
authors.initials: WL
authors.lastname: Hickerson
mesh_terms: D000081:Acetamides / Q000627:therapeutic use*; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D016984:Enterococcus faecium; D017809:Fatal Outcome; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D000069349:Linezolid; D023303:Oxazolidinones / Q000627:therapeutic use*; D007507:Therapeutic Irrigation; D001743:Urinary Bladder / Q000187:drug effects / Q000382:microbiology; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D020713:Vancomycin Resistance
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D000069349:Linezolid
keywords: bladder irrigation; burns; linezolid; urinary tract infection; vancomycin-resistant Enterococcus