Linezolid treatment of skeletal methicillin-resistant Staphylococcus aureus infection

Purpose: To investigate the role of linezolid in the treatment of skeletal methicillin-resistant Staphylococcus aureus (MRSA) infections in a university clinic for trauma surgery with regard to treatment results, side effects, practicability, and costs. Patients and Methods: Data were recorded retrospectively in a single center over a 1-year period. Four patients with MRSA osteitis/infected pseudarthrosis of the upper extremity following prolonged fracture treatment were administered linezolid, after therapy with established antibiotics such as vancomycin had failed. In two patients with vertebral osteitis due to progressive spondylodiscitis, linezolid was used as the only effective antibiotic with oral availability, when intravenous application was technically impossible (central venous line complications/vena cava thrombosis). Adequate surgical treatment (debridement, stabilization, osteosynthesis) was performed in all patients. Results: Linezolid was administered for a mean of 2.2 months (1.5-3 months). Side effects of intravenous or oral linezolid treatment were not seen. One patient died after 6 weeks (heart failure). Mean follow-up time was 17.4 months (13-24 months). MRSA arthritis after 12 months was observed in one patient. A second critically ill patient was diagnosed with MRSA infection of a prosthetic hip 15 months later. Reinfection was excluded in four patients. High daily costs also of oral linezolid application compete with advantages of an early ambulatory treatment. Conclusion: Linezolid is a potent antibiotic that should be left to skeletal MRSA infection after stabilization and debridement if (1) vancomycin treatment has failed and (2) intravenous application of vancomycin is not possible.