Empiric use of linezolid in febrile hematology and hematopoietic stem cell transplantation patients colonized with vancomycin-resistant Enterococcus spp
Objectives: We conducted a retrospective study on the impact of the empiric use of linezolid on mortality in vancomycin-resistant Enterococcus spp (VRE)-colonized hematology and hematopoietic stem cell transplantation (HSCT) patients. Methods: VRE-colonized inpatients for whom complete data were ava...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2015-04-01
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| Series: | International Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971215000296 |
| _version_ | 1818758052488151040 |
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| author | Luiz F. Lisboa Bianca G. Miranda Marjorie B. Vieira Frederico L. Dulley Guilherme G. Fonseca Thais Guimarães Anna S. Levin Maria A. Shikanai-Yasuda Silvia F. Costa |
| author_facet | Luiz F. Lisboa Bianca G. Miranda Marjorie B. Vieira Frederico L. Dulley Guilherme G. Fonseca Thais Guimarães Anna S. Levin Maria A. Shikanai-Yasuda Silvia F. Costa |
| author_sort | Luiz F. Lisboa |
| collection | DOAJ |
| description | Objectives: We conducted a retrospective study on the impact of the empiric use of linezolid on mortality in vancomycin-resistant Enterococcus spp (VRE)-colonized hematology and hematopoietic stem cell transplantation (HSCT) patients.
Methods: VRE-colonized inpatients for whom complete data were available (n = 100) were divided into two groups: those who received empiric linezolid in the course of fever refractory to broad-spectrum antibiotics, replacing the glycopeptide utilized for the previous 48 h, and those who did not (control group). All patients were followed until hospital discharge or death. The impact of linezolid and risk factors for all-cause mortality were evaluated; variables with p < 0.10 were analyzed in a multivariate model. A Kaplan–Meier survival analysis was done to compare survival among febrile patients colonized by VRE who received empiric linezolid with patients who did not receive linezolid.
Results: Patients empirically prescribed linezolid were generally younger (median age 33 vs. 44 years; p = 0.008) and more likely to be recipients of an allogeneic HSCT (24 (68.6%) vs. 24 (36.9%); p = 0.009) than patients who did not receive the drug. Fourteen (21.5%) VRE bloodstream infections were diagnosed, all in patients who did not receive empiric linezolid (p = 0.002). In-hospital mortality was comparable in empiric linezolid and non-linezolid users (19 (54.3%) vs. 27 (41.5%), respectively; p = 0.293). The Kaplan–Meier survival analysis showed no significant difference in survival comparing the group that received linezolid to the group that did not (p = 0.72). Graft-versus-host disease (GVHD; odds ratio (OR) 5.90, 95% confidence interval (CI) 1.46–23.79; p = 0.012) and persistence of neutropenia (OR 6.93, 95% CI 1.72–27.94; p = 0.0065) were independent predictors of all-cause in-hospital death in HSCT patients, and persistence of neutropenia in non-HSCT patients (OR 8.12, 95% CI 1.22–53.8; p = 0.030).
Conclusions: The empiric use of linezolid in VRE-colonized hematology patients had no impact on mortality, which appeared rather to be associated with the persistence of neutropenia in general and GVHD in the HSCT group. |
| first_indexed | 2024-12-18T06:20:42Z |
| format | Article |
| id | doaj.art-eabb22ee68344ecdbcd44098e8af943d |
| institution | Directory Open Access Journal |
| issn | 1201-9712 1878-3511 |
| language | English |
| last_indexed | 2024-12-18T06:20:42Z |
| publishDate | 2015-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-eabb22ee68344ecdbcd44098e8af943d2022-12-21T21:18:09ZengElsevierInternational Journal of Infectious Diseases1201-97121878-35112015-04-0133C17117610.1016/j.ijid.2015.02.001Empiric use of linezolid in febrile hematology and hematopoietic stem cell transplantation patients colonized with vancomycin-resistant Enterococcus sppLuiz F. Lisboa0Bianca G. Miranda1Marjorie B. Vieira2Frederico L. Dulley3Guilherme G. Fonseca4Thais Guimarães5Anna S. Levin6Maria A. Shikanai-Yasuda7Silvia F. Costa8Transplant Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, CanadaDepartment of Infectious Diseases, Faculty of Medicine, University of Sao Paulo, BrazilDepartment of Infectious Diseases, Faculty of Medicine, University of Sao Paulo, BrazilDiscipline of Hematology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, BrazilDiscipline of Hematology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, BrazilInfection Control Committee, Hospital das Clínicas, University of Sao Paulo, Sao Paulo, BrazilDepartment of Infectious Diseases, Faculty of Medicine, University of Sao Paulo, BrazilDepartment of Infectious Diseases, Faculty of Medicine, University of Sao Paulo, BrazilDepartment of Infectious Diseases, Faculty of Medicine, University of Sao Paulo, BrazilObjectives: We conducted a retrospective study on the impact of the empiric use of linezolid on mortality in vancomycin-resistant Enterococcus spp (VRE)-colonized hematology and hematopoietic stem cell transplantation (HSCT) patients. Methods: VRE-colonized inpatients for whom complete data were available (n = 100) were divided into two groups: those who received empiric linezolid in the course of fever refractory to broad-spectrum antibiotics, replacing the glycopeptide utilized for the previous 48 h, and those who did not (control group). All patients were followed until hospital discharge or death. The impact of linezolid and risk factors for all-cause mortality were evaluated; variables with p < 0.10 were analyzed in a multivariate model. A Kaplan–Meier survival analysis was done to compare survival among febrile patients colonized by VRE who received empiric linezolid with patients who did not receive linezolid. Results: Patients empirically prescribed linezolid were generally younger (median age 33 vs. 44 years; p = 0.008) and more likely to be recipients of an allogeneic HSCT (24 (68.6%) vs. 24 (36.9%); p = 0.009) than patients who did not receive the drug. Fourteen (21.5%) VRE bloodstream infections were diagnosed, all in patients who did not receive empiric linezolid (p = 0.002). In-hospital mortality was comparable in empiric linezolid and non-linezolid users (19 (54.3%) vs. 27 (41.5%), respectively; p = 0.293). The Kaplan–Meier survival analysis showed no significant difference in survival comparing the group that received linezolid to the group that did not (p = 0.72). Graft-versus-host disease (GVHD; odds ratio (OR) 5.90, 95% confidence interval (CI) 1.46–23.79; p = 0.012) and persistence of neutropenia (OR 6.93, 95% CI 1.72–27.94; p = 0.0065) were independent predictors of all-cause in-hospital death in HSCT patients, and persistence of neutropenia in non-HSCT patients (OR 8.12, 95% CI 1.22–53.8; p = 0.030). Conclusions: The empiric use of linezolid in VRE-colonized hematology patients had no impact on mortality, which appeared rather to be associated with the persistence of neutropenia in general and GVHD in the HSCT group.http://www.sciencedirect.com/science/article/pii/S1201971215000296LinezolidVREHematologyBone marrow transplant |
| spellingShingle | Luiz F. Lisboa Bianca G. Miranda Marjorie B. Vieira Frederico L. Dulley Guilherme G. Fonseca Thais Guimarães Anna S. Levin Maria A. Shikanai-Yasuda Silvia F. Costa Empiric use of linezolid in febrile hematology and hematopoietic stem cell transplantation patients colonized with vancomycin-resistant Enterococcus spp International Journal of Infectious Diseases Linezolid VRE Hematology Bone marrow transplant |
| title | Empiric use of linezolid in febrile hematology and hematopoietic stem cell transplantation patients colonized with vancomycin-resistant Enterococcus spp |
| title_full | Empiric use of linezolid in febrile hematology and hematopoietic stem cell transplantation patients colonized with vancomycin-resistant Enterococcus spp |
| title_fullStr | Empiric use of linezolid in febrile hematology and hematopoietic stem cell transplantation patients colonized with vancomycin-resistant Enterococcus spp |
| title_full_unstemmed | Empiric use of linezolid in febrile hematology and hematopoietic stem cell transplantation patients colonized with vancomycin-resistant Enterococcus spp |
| title_short | Empiric use of linezolid in febrile hematology and hematopoietic stem cell transplantation patients colonized with vancomycin-resistant Enterococcus spp |
| title_sort | empiric use of linezolid in febrile hematology and hematopoietic stem cell transplantation patients colonized with vancomycin resistant enterococcus spp |
| topic | Linezolid VRE Hematology Bone marrow transplant |
| url | http://www.sciencedirect.com/science/article/pii/S1201971215000296 |
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