Abstract
BackgroundLinezolid belongs to a reserve group of antibiotics. In recent years, reports on linezolid resistance in gram-positive cocci have become more frequent. Overuse of linezolid is a relevant factor for resistance development. The objective of this study was to describe current prescription practices of linezolid in German hospitals and identify targets for antimicrobial stewardship interventions.MethodsWe analyzed all linezolid prescriptions from the datasets of the consecutive national point prevalence surveys performed in German hospitals in 2011 and 2016. In both surveys, data on healthcare-associated infections and antimicrobial use were collected following the methodology of the European Centre for Disease Prevention and Control.ResultsOverall, the percentage of linezolid among all documented antimicrobials increased significantly from 2011 to 2016 (p < 0.01). In 2011, 0.3% (119 of 41,539) patients received linezolid, in 2016 this proportion was significantly higher (0.4%; 255 of 64,412 patients; p < 0.01). In 2016, intensive care units (ICUs) were the wards most frequently prescribing linezolid. The largest proportion of patients receiving linezolid were non-ICU patients. Roughly 38% of linezolid prescriptions were for treatment of skin/soft tissue and respiratory tract infections. In 2016, linezolid was administered parenterally in 70% (n = 179) of cases. Multivariable analysis showed that the ward specialty ICU posed an independent risk factor, while Northern and Southwestern regions in Germany were independent protective factors for a high rate of linezolid prescriptions.ConclusionsIn conclusion, we detected potentials for improving linezolid prescription practices in German hospitals. Given the emergence of linezolid resistance, optimization of linezolid use must be a target of future antimicrobial stewardship activities.
Highlights
Linezolid belongs to a reserve group of antibiotics
With its classification as a reserve group antibiotic by the World Health Organization, many applications of linezolid have to be regarded as off-label
Given the relevance of this topic and the lack of robust epidemiological data on the subject, the objective of our study was to describe the current practices of linezolid use in German hospitals and to identify targets for antimicrobial stewardship efforts to promote the prudent use of linezolid
Summary
Linezolid belongs to a reserve group of antibiotics. In recent years, reports on linezolid resistance in gram-positive cocci have become more frequent. In the early 2000s, linezolid was introduced into the German market It was licensed for the treatment of certain bacterial infections caused by methicillin-resistant. With its classification as a reserve group antibiotic by the World Health Organization, many applications of linezolid have to be regarded as off-label. This especially applies to the treatment of bone and joint infections [5,6,7,8,9], peritonitis [10], bacteremia [11,12,13,14], and endocarditis [15]. The excellent oral bioavailability opened new opportunities [16]
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