title: Assessment of linezolid prescriptions in three French hospitals.
abstract: The use of linezolid to treat gram-positive cocci infections is increasing in France. Linezolid is approved in pneumonia and complicated skin and soft tissue infections. Overuse and misuse of linezolid can favor the emergence and spreading of linezolid-resistant strains. We aimed to assess the appropriateness of linezolid use in French hospitals. This is a multicenter, retrospective study conducted in three tertiary care hospitals. Appropriateness of linezolid indications and adequacy (composite score concerning dosage, route of administration and blood monitoring) were assessed. Over a three-month period, all prescriptions of linezolid were extracted and analyzed by two independent infectious disease experts. Among the 81 initial prescriptions that were evaluated, indication was appropriate in 48% of cases. Among those, 51% complied with international guidelines. Fifty-seven percent of the prescriptions were adequate regarding dosage, route of administration and blood monitoring. Overall, 23% of prescriptions combined both appropriateness and adequacy. The most frequent reasons for inappropriateness were the possibility of choosing narrower-spectrum antibiotics and the empirical use of linezolid in severe sepsis or septic shock. Initial treatment was the most frequently appropriate in bone and joint infection cases (p = 0.001). Our study shows that even if modalities of use were mostly correct, appropriateness of linezolid indications is low. Educational programs are mandatory to improve practices, as well as clinical studies to better assess the efficacy and safety of linezolid in clinical situations other than pneumonia or complicated skin and soft tissue infections.
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France. Cdentan@chu-grenoble.fr.
authors.forename: C
authors.identifier: http://orcid.org/0000-0003-1732-6771
authors.initials: C
authors.lastname: Dentan
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Métropole Savoie, Chambéry, France.
authors.forename: E
authors.initials: E
authors.lastname: Forestier
authors.affiliation: Pharmacologie, Université Grenoble Alpes; Pôle Recherche, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.
authors.forename: M
authors.initials: M
authors.lastname: Roustit
authors.affiliation: Laboratoire de Bactériologie-Hygiène, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.|Laboratoire TIMC-IMAG, UMR 5525 CNRS, Université Grenoble Alpes, Grenoble, France.
authors.forename: S
authors.initials: S
authors.lastname: Boisset
authors.affiliation: Institute of Advanced Biosciences (IAB), Centre de Recherche UGA - INSERM U1209 - CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France.|Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.
authors.forename: S
authors.initials: S
authors.lastname: Chanoine
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.
authors.forename: O
authors.initials: O
authors.lastname: Epaulard
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.
authors.forename: P
authors.initials: P
authors.lastname: Pavese
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization; D005260:Female; D005602:France; D019983:Guideline Adherence; D006801:Humans; D000069349:Linezolid / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D055656:Prescriptions; D012189:Retrospective Studies; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents; D000069349:Linezolid