Abstract
BackgroundLinezolid has been increasingly used in tertiary NICUs. The objectives of this study were to explore the indications of these linezolid prescriptions, to analyze a possible misuse and to provide solutions to avoid such misuse.MethodsA monocentric retrospective cohort study included all neonates hospitalized in one tertiary NICU between January 1st, 2010 and December 31st, 2019 and who received at least one administration of linezolid. These data were confronted to epidemiological and antibiotic use data from the same NICU. Two independent pediatricians secondarily classified linezolid uses as adequate or not.ResultsDuring the study period, 66 infections in 57 patients led to linezolid use. Most patients were pre-term and 21 patients (37%) died. Infections were mainly related to methicillin-resistant coagulase negative staphylococci and were frequently either pneumoniae (35%) or isolated bacteremia (48%), including 25 persistent bacteremia (64% of the 39 bacteremia). Need for a better tissue distribution or first-line treatment failure were the main reasons to initiate linezolid. Linezolid was administered for a median duration of 7 [3;10] days. No side effects were reported. Twenty-two (33%) of the 66 linezolid prescriptions were retrospectively classified as inadequate.ConclusionsA rapid increase in linezolid prescriptions has been observed in our tertiary NICU, from 2014 to 2019, with 33% inadequate uses. This worrisome trend should lead to search for therapeutic alternatives and to work on antibiotic stewardship to prevent the emergence of new antimicrobial bacterial resistance.
Highlights
Linezolid has been increasingly used in tertiary neonatal intensive care units (NICU)
Linezolid seems to constitute a good alternative to vancomycin because of its wide bacterial spectrum, its ubiquitous tissue distribution and its excellent bioavailability allowing for an oral administration [5,6,7,8,9]
All neonates hospitalized in this NICU between 1st January 2010 and 31st December 2019 for whom at least one administration of linezolid was encoded in the medical record were eligible for inclusion
Summary
Linezolid has been increasingly used in tertiary NICUs. The objectives of this study were to explore the indications of these linezolid prescriptions, to analyze a possible misuse and to provide solutions to avoid such misuse. With advances in neonatal care over the past decades, the survival of these vulnerable neonates has increased, but so did the use of long-. Linezolid is an alternative antibiotic belonging to the oxazolidinone class, active against methicillin-resistant Gram positive bacteria and is approved for clinical use since the early 2000s. In the literature we observe a constant and rapid increase of the articles reporting its use in neonates. Some NICUs have reported on the increasing use of this antibiotic at the local scale [10, 11]. Such an increase has been observed in our NICU setting in Lyon, France over the past decade
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