Linezolid for therapy of Staphylococcus aureus meningitis: a cohort study of 26 patients

Abstract

Background

Linezolid has good penetration to the meninges and could be an alternative for treatment of Staphylococcus aureus meningitis. We assessed the efficacy and safety of linezolid therapy for this infection.

Methods

Retrospective multicenter cohort study of 26 adults treated with linezolid, derived from a cohort of 350 cases of S. aureus meningitis diagnosed at 11 university hospitals in Spain (1981-2015).

Results

There were 15 males (58%) and mean age was 47.3 years. Meningitis was postoperative in 21 (81%) patients. The infection was nosocomial in 23 (88%) cases, and caused by methicillin-resistant S. aureus in 15 cases and methicillin-susceptible S. aureus in 11. Linezolid was given as empirical therapy in 10 cases, as directed therapy in 10, and due to failure of vancomycin in 6. Monotherapy was given to 16 (62%) patients. Median duration of linezolid therapy was 17 days (IQR 12-22 days) with a daily dose of 1,200 mg in all cases. The clinical response rate to linezolid was 69% (18/26) and microbiological response was observed in 14 of 15 cases evaluated (93%). Overall 30-day mortality was 23% and was directly associated with infection in most cases. When compared with the patients of the cohort, no significant difference in mortality was observed between patients receiving linezolid or vancomycin for therapy of methicillin-resistant S. aureus meningitis (9% vs. 20%; p = .16) nor between patients receiving linezolid or cloxacillin for therapy of methicillin-susceptible S. aureus meningitis (20% vs 14%; p = .68). Adverse events appeared in 14% (3/22) of patients, but linezolid was discontinued in only one patient.

Conclusions

Linezolid appears to be effective and safe for therapy of S. aureus meningitis. Our findings showed that linezolid may be considered an adequate alternative to other antimicrobials in meningitis caused by S. aureus.

Keywords:

• Linezolid
• meningitis
• Staphylococcus aureus
• methicillin-resistant

Acknowledgments

We acknowledge Professor Santiago Moreno (Infectious Diseases Service, Hospital Ramón y Cajal, Madrid) for critical review of the manuscript, and Professor Alfonso Muriel (Biostatistics Unit, Hospital Ramón y Cajal, Madrid) for assistance in the analysis of the data.

Ethics approval

The study was approved by the Ethics Committee of the Hospital Ramón y Cajal (Madrid, Spain). Informed consent was waived because no intervention was involved and no identifying patient information was included. The study complies with the principles of the 1964 Helsinki Declaration and its later amendments.

Disclosure statement

The authors declare that they have no conflict of interest.

Authors’s contributions

All the authors participated sufficiently in the conception, analysis of the data, design and writing of the manuscript and take public responsibility for it. All the authors believe that the manuscript represents valid work and all have reviewed and approved the final version for publication.