Sequential antimicrobial treatment with linezolid for neurosurgical infections: efficacy, safety and cost study.

BACKGROUND: Evidence for the effectiveness of linezolid in neurosurgical infections (NSIs) is growing. The comfortable oral dosage and tolerance of linezolid opens the possibility for sequential antimicrobial treatment (SAT) in stable patients after a period of intravenous treatment. METHODS: To evaluate the efficacy and safety of SAT with oral linezolid in patients with NSI and to analyse the cost implications, an observational, non-comparative, prospective cohort study was conducted on clinically stable consecutive adult patients at the Neurosurgical Service. Following intravenous treatment, patients were discharged with SAT with oral linezolid. RESULTS: A total of 77 patients were included. The most common NSIs were: 41 surgical wound infections, 20 subdural empyemas, 18 epidural abscesses, and 16 brain abscesses. Forty-four percent of patients presented two or more concomitant NSIs. Aetiological agents commonly isolated were: Propionibacterium acnes (36 %), Staphylococcus aureus (23 %), Staphylococcus epidermidis (21 %) and Streptococcus spp. (13 %). The median duration of the SAT was 15 days (range, 3-42). The SAT was interrupted in five cases due to adverse events. The remainder of the patients were cured at the end of the SAT. A total of 1,163 days of hospitalisation were saved. An overall cost reduction of €516,188 was attributed to the SAT. Eight patients with device infections did not require removal of the device, with an additional cost reduction of €190,595. The mean cost saving per patient was €9,179. CONCLUSIONS: SAT with linezolid was safe and effective for the treatment of NSI. SAT reduces hospitalisation times, which means significant savings of health and economic resources.

Superinfection during treatment of nosocomial infections with tigecycline.

We performed a retrospective and observational study of 51 patients treated with tigecycline, as the treatment for nosocomial infections due to multidrug-resistant microorganisms, to evaluate the superinfection rate and their etiologies. Superinfections were diagnosed in 12 (23.5%) patients (seven due to Pseudomonas aeruginosa, 13.7%) and one patient had P. aeruginosa colonization. Five patients with superinfection died (41.6%), three due to superinfections and two to underlying diseases. The superinfection rate observed during tigecycline treatment is higher than that previously reported. Pseudomonas aeruginosa is the most frequent agent, being the cause of 58.5% of all superinfections.

[Bacteremia caused by Stenotrophomonas maltophilia: epidemiology, clinical features, and prognosis factors]. / Bacteriemias por Stenotrophomonas maltophilia: epidemiología, características clínicas y factores pronósticos.

The epidemiologic, clinical and prognostic characteristics of Stenotrophomonas maltophilia bacteremias for a six-year period (January 1993 to December 1998) were reviewed. Twenty episodes of S. maltophilia bacteremia were include, which represented 0.62% of all bacteremias caused by gram-negative rods during that period. Seventy percent of bacteremias were clinically significant. The most common predisposing factors were the previous use of antimicrobial agents and the presence of vascular catheters. In most cases (57%), the origin of bacteremia was the intravascular catheter. The course of patients was favorable and all patients cured.

Bacteriemias por stenotrophomonas maltophilia: epidemiología, características clínicas y factores pronósticos / Stenotrophomonas maltophilia bacteremia: epidemiology, clinical characteristics and prognostic factors

Se revisan las características epidemiológicas, clínicas y pronósticas de las bacteriemias por Stenotrophomonas maltophilia durante un período de seis años (enero de 1993-diciembre de 1998). Se incluyeron 20 episodios de bacteriemia por S. maltophilia que representan el 0,62 por ciento de las bacteriemias por bacilos gramnegativos de ese período. El 70 por ciento de las bacteriemias fueron clínicamente significativas. Los factores predisponentes más frecuentes fueron el uso previo de antimicrobianos y la presencia de catéter vascular. El origen de la bacteriemia fue el catéter intravascular en la mayoría de los casos (57 por ciento). La evolución de los pacientes fue favorable, alcanzando la curación en todos los casos (AU)