Linezolid versus daptomycin treatment for periprosthetic joint infections: a retrospective cohort study

Masahiro Sawada,Hiroshi Kawamura,Masayuki Hirata,Takanori Saito,Tomohisa Nakamura,Narumi Ueda,Kenichi Oe,Hirokazu Iida

doi:10.1186/s13018-019-1375-7

Masahiro Sawada, Hiroshi Kawamura + Show 6 more

Open Access

https://doi.org/10.1186/s13018-019-1375-7

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Abstract

BackgroundLinezolid (LZD) and daptomycin (DAP) are predominantly used to target gram-positive pathogens; however, treatment effectiveness and adverse reactions for periprosthetic joint infections (PJIs) remain unknown. The aim of this study was to compare the effectiveness and adverse reactions of LZD and DAP for PJIs.MethodsThis study retrospectively evaluated 82 patients between June 2009 and December 2017, to compare the effectiveness of LZD (group L, n = 39) and DAP (group D, n = 43) for treatment of PJIs harboring gram-positive microorganisms. Surgical options used with LZD or DAP therapy included implant retention, implant removal, and a shift to another appropriate antibiotic. Infection control was defined as not requiring implant removal after the final treatment.ResultsGram-positive pathogens were isolated from 72% of group L and 70% of group D patients, respectively. Whole infection control rates against gram-positive pathogens in groups L and D were 79% and 77%, respectively. Furthermore, infection control rates were 94% and 58% in group L and 75% and 80% in group D, without and with implant removal, respectively. Significantly higher clinical success rates and lower adverse event rates were observed in group D, including higher red blood cell and platelet counts and lower C-reactive protein (CRP) levels.ConclusionsAlthough the effectiveness of LZD and DAP was equivalent in terms of infection control rates for refractory PJIs with gram-positive pathogens, DAP therapy significantly decreased CRP levels and caused fewer adverse events than LZD treatment.

Highlights

Linezolid (LZD) and daptomycin (DAP) are predominantly used to target gram-positive pathogens; treatment effectiveness and adverse reactions for periprosthetic joint infections (PJIs) remain unknown
In PJIs, subclinical infections frequently occur by conventional diagnostic procedures because the bacteria subsist within biofilms on implant surfaces [2]
There were no contraindications because gram-positive bacteria caused the majority of PJIs and the antibiotic resistance was difficult to overcome

Summary

Introduction

Linezolid (LZD) and daptomycin (DAP) are predominantly used to target gram-positive pathogens; treatment effectiveness and adverse reactions for periprosthetic joint infections (PJIs) remain unknown. The gold standard for managing PJIs includes both implant removal and Linezolid (LZD) and daptomycin (DAP), which are specific antibiotics used to treat gram-positive pathogens, are currently available as novel antibiotic therapies worldwide. LZD, the first oxazolidinone antimicrobial, inhibits bacterial protein synthesis by preventing the fusion of the 30S and 50S ribosomal subunits It shows excellent efficacy against gram-positive bacteria, but sometimes induces immunosuppression [8]. The effectiveness and adverse reactions of these treatments for PJIs are unknown, and few reports have compared LZD and DAP. The aim of this study was to compare the effectiveness and adverse reactions of LZD and DAP as treatments for PJI. We hypothesized that there would be significantly fewer adverse events associated with DAP therapy than with LZD therapy, the effectiveness of LZD and DAP therapy appears equivalent

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