Comparative effectiveness of linezolid versus vancomycin as definitive antibiotic therapy for heterogeneously resistant vancomycin-intermediate coagulase-negative staphylococcal central-line-associated bloodstream infections in a neonatal intensive care unit.
Heterogeneously resistant vancomycin-intermediate coagulase-negative staphylococci (hVICoNS) are emerging pathogens causing central-line-associated bloodstream infections (CLABSIs) in neonatal intensive care unit (NICU) patients. Given the burden of disease associated with CLABSI and the current lack of therapeutic guidelines, we aimed to compare the effectiveness of linezolid versus vancomycin used as the definitive antibiotic therapy for hVICoNS CLABSI.



We performed a retrospective cohort study of infants with hVICoNS CLABSI from a single NICU between 2009 and 2014, treated with either linezolid or vancomycin as definitive antibiotic therapy. CLABSI duration, early and late recurrence and in-hospital mortality were compared using propensity score-adjusted proportional hazards and logistic regression models.



Of 89 infants with hVICoNS CLABSI, 33 (37.1%) treated with linezolid were compared with 56 (62.9%) treated with vancomycin. The median duration of CLABSI was 5 (range 1-12) versus 4 days (range 0-14) ( P  =   0.11), early recurrences were 3.0% versus 7.1% ( P  =   0.42), late recurrences 0% versus 14.3% ( P  =   0.02) and mortality 27.3% versus 28.6% ( P  =   0.90), when treated with linezolid versus vancomycin, respectively. When adjusting using a continuous propensity score, linezolid had an HR of 0.78 (95% CI 0.48-1.27) for CLABSI duration, an OR of 0.23 (95% CI 0.02-2.56) for early recurrence and an OR of 0.9 (95% CI 0.3-2.67) for mortality, relative to vancomycin.



There was no statistically significant difference between linezolid and vancomycin when used as definitive treatment for hVICoNS CLABSI in NICU patients, in terms of CLABSI duration, recurrence or all-cause mortality.
Department of Pediatrics, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.
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Blanchard
Direction des Risques Biologiques et de la Santé au Travail, Institut National de Santé Publique du Québec, Québec, Canada.
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Fortin
Department of Microbiology, Infection Control and Prevention Unit, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.
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Laferrière
Department of Pharmacy, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.
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Goyer
Division of Neonatology, Department of Pediatrics, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.
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Moussa
Infectious Diseases Division, Department of Pediatrics, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.|Department of Pharmacology, University of Montreal, Montreal, Quebec, Canada.
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Autmizguine
Direction des Risques Biologiques et de la Santé au Travail, Institut National de Santé Publique du Québec, Québec, Canada.
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Quach
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D003030:Coagulase / Q000172:deficiency; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D000069349:Linezolid / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D008297:Male; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D013210:Staphylococcus / Q000145:classification / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D003030:Coagulase; D014640:Vancomycin; D000069349:Linezolid