Research Report
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Orthop. Apr 18, 2014; 5(2): 151-157
Published online Apr 18, 2014. doi: 10.5312/wjo.v5.i2.151
Clinical results of linezolid in arthroplasty and trauma MRSA related infections
James Joel, Simon Matthew Graham, Adam Peckham-Cooper, Nectarios Korres, Helen Tsouchnica, Eleftherios Tsiridis
James Joel, Adam Peckham-Cooper, Academic Orthopaedic and Trauma Unit, Leeds Teaching Hospitals, Leeds School of Medicine, Leeds LS1 3EX, United Kingdom
Simon Matthew Graham, Royal Liverpool University Hospital, Liverpool L7 8XP, United Kingdom
Nectarios Korres, Helen Tsouchnica, Eleftherios Tsiridis, Academic Orthopaedics and Trauma Unit, Division of Surgery, Aristotle University Medical School, University Campus, 54 124 Thessaloniki, Greece
Author contributions: Joel J, Graham SM and Peckham-Cooper A contributed equally to this work in designing, writing and editing the paper; Korres N and Tsouchnica H assisted with the data collection; Tsiridis E designed the study and oversaw all areas of data collection and writing up of the paper.
Correspondence to: Eleftherios Tsiridis, MD, MSc, DMed, PhD, FRCS, Associate Professor of Orthopaedics and Trauma, Academic Orthopaedic and Trauma Unit, Division of Surgery, Aristotle University Medical School, University Campus, Kiriakidi 1, 54 124 Thessaloniki, Greece.
Telephone: +30-210-3620666 Fax: +30-210-3620666
Received: October 17, 2013
Revised: February 10, 2014
Accepted: March 3, 2014
Published online: April 18, 2014

AIM: To analyse the management of patients treated with linezolid for orthopaedic infections.

METHODS: Twenty-two patients with orthopaedic related infections receiving a course of linezolid were reviewed retrospectively. Patients were classified into either post trauma, post arthroplasty and non trauma related infections. A diagnosis of infection was based on clinical findings, positive microbiological specimens, and positive signs of infection on radiological imaging and raised inflammatory markers. Pathogens isolated, inflammatory markers both at presentation and at final follow up, length of linezolid treatment, adverse drug reactions, concomitant anti-microbial therapy, length of hospital stay and any surgical interventions were recorded.

RESULTS: Infections were classified as post arthroplasty (n = 10), post trauma surgery (n = 8) or non-trauma related infections (n = 4). Twenty patients (91%) underwent surgical intervention as part of their treatment. The number of required surgical procedures ranged from 1 to 6 (mean = 2.56). Mean total length of stay per admission was 28.5 d (range 1-160 d). Furthermore, the mean duration of treatment with linezolid of patients who had resolution of symptoms was 31 d (range 10-84 d). All patients within this group were discharged on oral linezolid. Pathogens isolated included methicillin resistant Staphylococcus aureus, coagulase negative staphylococci, coliforms, enterococcus, Staphylococcus epidermidis, streptococcus viridans, Escherichia coli, group B streptococcus and pseudomonas. An overall 77% of patients demonstrated resolution of infections at follow-up, with mean C-reactive protein reducing from 123 mg/L to 13.2 mg/L.

CONCLUSION: This study demonstrates that the use of linezolid offers excellent efficacy in orthopaedic related infections when used alongside appropriate surgical management.

Keywords: Antibiotic resistance, Linezolid, Orthopaedic infections, Osteomyelitis, Periprosthetic joint infection

Core tip: Our study demonstrates that linezolid delivers excellent oral bioavailability, with good penetration into bone, joints and soft tissue. It exhibits action against gram-positive organisms, including methicillin resistant Staphylococcus aureus and vancomycin resistant enterococci, and it is ideally suited for the variety of infections encountered in orthopaedic practice. Used in conjunction with surgical management, excellent results can be achieved in resolving infection.