Experience with linezolid for the treatment of nocardiosis in organ transplant recipients

Abstract

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. Retrospective review of cases of nocardiosis in SOT at a large center from 2006 to 2012. 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. 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.