Authors: M. Vercillo, C.G. Zalavras*, M.J. Patzakis
Title: Clinical Experience with Linezolid in the Treatment of Implant-Related Chronic Osteomyelitis
Addresses: Department of Orthopaedics, LAC+USC Medical Center, University of Southern California, Keck School of Medicine, 1200 N State St, GNH 3900, Los Angeles, CA 90033
Purpose: Development of resistant organisms is a major concern. New antibiotic agents have been developed for the management of such infections, however limited information is available on their use in implant-related chronic osteomyelitis. The purpose of the current study is to present our experience regarding the indications and efficacy of linezolid in these challenging infections.
Methods: This retrospective study included adult patients admitted to the musculoskeletal infection ward of our institution with the diagnosis of chronic implant-related osteomyelitis and treated with linezolid as the definitive antibiotic agent in addition to surgical debridement, implant removal, and soft tissue management. There were 22 consecutive patients (14 male and 8 female) with a mean age of 46 years (21 to 74 years). Fourteen patients (64%) had one or more co-morbidities, including intravenous drug abuse in 4 patients. Osteomyelitis was associated with the presence of fracture fixation implants (n = 18) or arthroplasty implants (n = 4). Oxacillin-resistant Staphylococcus aureus (ORSA) was the most common pathogen, present in 10 of 22 patients (45%).
Results: Indications for use of linezolid included the preference for oral adminstration in 13 patients (59%), the presence of vancomycin-resistant enterococcus (VRE) in 5 patients (23%), and development of allergic reactions to vancomycin in 4 patients (18%). Fourteen patients were followed-up for a mean time of 22 months (6 to 34 months) and no recurrence of infection was observed.
Discussion: Linezolid can be administered orally with satisfactory bioavailability, which makes this new antibiotic useful in the setting of outpatient therapy. This may be particularly important in patient subgroups where intravenous therapy may be problematic, such as IVDA. Linezolid achieved control of infection in all patients with adequate follow-up, despite the challenging nature of these infections due to the presence of patient comorbidities and resistant organisms.
Linezolid is a viable antibiotic option for the management of chronic implant-related osteomyelitis.