Proper use of antibiotics:: a prospective study on the use of linezolid in a french university hospital

Aim of the study. - To describe clinical use of a new antibiotic: linezolid, in a French university hospital, on a population of patients different from the one studied during the clinical trials for the marketing authorisation. Patients and methods. - An observational, prospective cohort study performed in patients treated by linezolid between November 2005 and June 2006 at Saint Andre hospital (Bordeaux University Hospital). The following data were collected: sources of infection, isolated pathogens, patient's background, antibiotherapy strategies, duration of therapy and evolution. Results. - Fifty patients (intensive care, internal medicine) were included. The absence of local guidelines on proper use of linezolid led to various prescriptions as well in infections listed in the marketing authorisation: nosocomial pneumonia and ventilator associated pneumonia (48%), skin and soft tissue infections (11%), as in endocarditis (7%), intra-abdominal infections (13%), bone and joint infections (2%), catheter infections (13%) and febrile neutropenic patients (6%). The main justification for using linezolid was worsening renal dysfunction (66%), which contra indicated glycopeptides use. Isolated pathogens were for the major part staphylococcus. Conclusion. - In the context of proper use of antibiotics, it would be advisable to add new recommendations on the use of linezolid to the hospital's antibiotherapy guide which would constitute a tool for the prescribing clinicians, and to re-evaluate the impact during a second evaluation. (C) 2007 Elsevier Masson SAS. Tons droits reserves.