Increasing use of linezolid in a tertiary NICU during a 10-year period: reasons and concerns for the future
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(2020) 9:156
RESEARCH
Open Access
Increasing use of linezolid in a tertiary NICU during a 10-year period: reasons and concerns for the future Lucie Matrat1, Frank Plaisant1, Christine Barreto2, Olivier Claris1,3 and Marine Butin1,4*
Abstract Background: 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. Methods: A 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. Results: During 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. Conclusions: A 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. Keywords: Linezolid, Vancomycin, NICU, Late-onset sepsis, Multidrug resistance
Background At birth, neonates can be hospitalized in neonatal intensive care units (NICUs) for a variety of reasons, prematurity being the leading one. With advances in neonatal care over the past decades, the survival of these vulnerable neonates has increased, but so did the use of long* Correspondence: [email protected] 1 Service de Néonatologie et Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France 4 CIRI, Centre International de Recherche en Infectiologie, Inserm U1111; CNRS UMR5308; Ecole Normale Supérieure de Lyon; Université Lyon 1, Lyon, France Full list of author information is available at the end of the article
term invasive procedures and devices, exposing neonates to an increasing risk of nosocomial infections [1]. The lack of specificity of septic signs in neonates and the high frequency of nosocomial sepsis in NICUs lead to wide antibiotic indications (with rapid de-escalation if the diagnosis is refuted) [2]. Because the bacteria that are the most frequently involved in these infections are Gram positive bacteria including by order of fr
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