血液分离利奈唑胺耐药头状葡萄球菌耐药性及相关临床特征分析

目的了解利奈唑胺耐药头状葡萄球菌血流感染的临床及病原菌耐药特点。方法收集利奈唑胺耐药头状葡萄球菌血液分离株,并测定药敏;PCR及测序检测耐药基因cfr及23S rRNA耐药突变;临床分离株用脉冲场凝胶电泳(PFGE)进行同源性分析;病例资料分析。结果从3例患者血标本中分离到5株利奈唑胺耐药头状葡萄球菌;这些临床分离株对苯唑西林、左氧氟沙星、庆大霉素等常用抗菌药物耐药,仅对糖肽类、利福平和甲氧苄啶-磺胺甲唑敏感;5株耐药菌的23S rRNA均存在突变,4株携带cfr基因;PFGE显示5株临床株属同一谱型;3例患者均有留置深静脉导管,2例曾接受利奈唑胺治疗。结论利奈唑胺耐药头状葡萄球菌呈多重耐药表型;头状葡萄球菌对利奈唑胺耐药由23S rRNA突变及cfr基因导致;长疗程使用利奈唑胺及留置深静脉导管可能是此类耐药菌感染的危险因素。     

利奈唑胺与万古霉素治疗革兰氏阳性菌血症效果比较的系统评价

目的比较利奈唑胺和万古霉素治疗革兰氏阳性菌血症的疗效和安全性。方法计算机检索Cochrane图书馆（2009年第1期）、Cochrane图书馆临床对照试验资料库（2009年第l期）、MEDLINE、EMbase、Current Controlled Trials、The National Research Register、中国生物医学文献数据库、中文科技期刊全文数据库和中文学术期刊全文数据库,手丁检索相关会议的中英文论文集。纳入比较利奈唑胺和万古霉素治疗革兰氏阳性菌血症疗效和安全性的随机对照试验（RCT）,评价纳入研究的内部真实性。检索时间均从建库至2009年3月10日,并采用RevMan5．0进行Meta分析。结果共纳入8个RCT,共670例患者。Meta分析结果显示,利奈唑胺在治疗革兰氏阳性菌血症方面与万古霉素疗效相当[RR=1．07,95％CI（0．98,1．17）,P=0．15]。对于耐甲氧两林金葡菌引起的菌血症,尽管利奈唑胺临床治愈率略高于万古霉素,但差异并无统计学意义[RR=I．22,95％CI（0．97,1．53）,P=0．10]。在治疗导管相关性菌血症中,利奈唑胺与万古霉素疗效相当[RR=1．01,95％CI（0．86,1．19）,P=0．90.利余唑胺和万古霉素不良反应发生率无明显差异（P=0．64）,两种药物引起贫血的发生率也无明显差异（P=0．48）.万古霉素组发生肾功能不全的几率为2．51％,明显高于利奈唑胺组的0．47％（P=0．0003）,而利奈唑胺引起血小板减少症的几率为4．39％,明显高于万古霉素组的1．35％（P=0．01）.结论目前的研究提示,利奈唑胺在治疗革兰氏阳性菌血症方面的疗效与万古霉素相当。考虑到利奈唑胺较好的耐受性和较小的肾毒性,在治疗万古霉素耐药患背、亟症患者,尤其合并肾功能不全时,可以考虑选用利奈唑胺替代万古霉素进行治疗。     

脑脊液与血清利奈唑胺浓度监测指导颅内感染临床治疗的价值

目的监测神经外科手术后颅内感染患者应用利奈唑胺抗感染治疗时脑脊液利奈唑胺药物浓度及血脑屏障通透率,指导利奈唑胺临床应用。 方法选取2019年6月至2019年11月入住青岛大学附属医院神经外科监护室的颅脑术后感染患者6例,静脉应用利奈唑胺抗感染治疗。连续监测患者脑脊液及血液利奈唑胺浓度、脑脊液常规、脑脊液生化及一般生命体征,分析利奈唑胺血脑屏障通透率。 结果利奈唑胺给药前0.5 h的血清和脑脊液药物谷浓度分别为（4.65±2.72）μg/ml和（3.78±1.53）μg/ml。在开始用药后2 h,血清中利奈唑胺的最大平均浓度为（12.53±3.79）μg/ml,而脑脊液中最大平均浓度为（5.55±2.00）μg/ml。脑脊液利奈唑胺曲线下面积/血清曲线下面积约为45%。所有患者应用利奈唑胺抗感染治疗后,颅内感染均得到治愈。 结论利奈唑胺具有满意的血脑屏障通透率,临床治疗效果良好。静脉应用利奈唑胺脑脊液浓度个体间差异大,推荐临床监测脑脊液浓度指导应用。     

利奈唑胺治疗老年脑卒中合并MRSA肺部感染的疗效及成本-效果分析

【目的】探讨利奈唑胺治疗老年脑卒中合并耐甲氧西林金黄色葡萄球菌(MRSA)肺部感染的疗效及成本-效果分析。【方法】回顾性分析两院收治的70例老年脑卒中合并MRSA肺部感染患者的临床资料,其中采用利奈唑胺治疗38例,万古霉素治疗32例,分别记为利奈唑胺组和万古霉素组。比较两组患者治疗后细菌清除率、临床疗效和治疗期间不良反应发生情况。分析两组治疗的成本-效果情况。【结果】利奈唑胺组治疗后细菌清除率高于万古霉素组(P<0.05)。两组患者临床疗效、不良反应发生率比较,差异均无统计学意义(P>0.05)。利奈唑胺组、万古霉素组获得每个单位细菌清除效果成本分别为604.65元、582.91元;利奈唑胺组、万古霉素组获得每个临床疗效效果成本分别为585.76元、485.76元;利奈唑胺组成本/效果高于万古霉素组,且细菌清除率、临床有效率每增加一个单位效果,比万古霉素组分别多付出675.84元、1400.11元。【结论】万古霉素与利奈唑胺两者用于治疗老年脑卒中合并MRSA肺部感染疗效及安全性相当,但与万古霉素相比,利奈唑胺可提高细菌清除率,且成本-效果可观。     

特地唑胺对利奈唑胺不敏感革兰阳性球菌的体外抗菌活性研究

摘要:目的检测利奈唑胺不敏感革兰阳性球菌对新型噫唑烷酮类抗菌药物特地唑胺的敏感性，并探讨特地唑胺不敏感菌株 的耐药机制。方法收集临床分离非重复革兰阳性球菌 170株,包括利奈唑胺耐药头状葡萄球菌46株、利奈唑胺敏感头状葡 萄球菌19株、利奈唑胺不敏感肠球菌55株、利奈唑胺敏感肠球菌12株、甲氧西林耐药金黄色葡萄球菌19株、甲氧西林敏感 金黄色葡萄球菌18株、利奈唑胺耐药金黄色葡萄球菌1株。采用微量肉汤稀释法检测所有菌株对特地唑胺和利奈唑胺的最 小抑茵浓度(MIC),并比较两种药物的抗菌活性。采用PCR结合Sanger测序技术分析特地唑胺不敏感革兰阳性球茵fr、optrA 基因携带情况及23S rRNA V区突变。结果利奈唑胺耐药头状葡萄球茵(MICg0>256 μg/mL)对特地唑胺的MIC 值为4~ 32 ug/mL; 利奈唑胺不敏感肠球菌(MIC值4~ 16 μg/mL)中,特地唑胺的敏感率为10.% ,其MIC值为0.5~2 μg/mL;1株利奈 唑胺耐药金黄色葡萄球菌对特地唑胺敏感，MIC值为0.5μg/mL。特地唑胺对利奈唑胺敏感的金黄色葡萄球茵和肠球茵的 MIC值均为0.5 μg/mL,对利奈唑胺敏感头状葡萄球菌的MIC值为0. 125 μg/mL。耐药基因分析显示，特地唑胺耐药头状葡萄 球菌gfr基因携带率为87.0%(40/46) ,23S rRNA V区G2576T的突变率为100% ;特地唑胺不敏感肠球菌optrA 基因携带率为 85.7% (42/49) ,显著高于特地唑胺敏感株的22.2%( P<0.001);1株利奈唑胺耐药特地唑胺敏感的金黄色葡萄球菌携帶cfr基 因。结论对于利奈唑胺不敏感的革兰阳性球菌,特地唑胺的抗茵活性是利奈唑胺的8~32倍,其耐药机制可能与携带optrA 基因及23S rRNA V区G2576T突变有关。     

利奈唑胺与万古霉素治疗老年耐甲氧西林的金黄色葡萄球菌肺炎的临床疗效分析

目的 分析评价利奈唑胺和万古霉素治疗老年耐甲氧西林的金黄色葡萄球菌(MRSA)肺炎的临床疗效及安全性.方法 分析我院呼吸科25例接受万古霉素和15例接受利奈唑胺治疗的老年MRSA肺炎患者的临床治愈率、细菌清除率及治疗前后血清炎症因子肿瘤坏死因子(TNF-α)、C反应蛋白(CRP)的水平变化及不良反应发生率.结果 利奈唑胺治疗MRSA肺炎的临床有效率为86.7%、细菌清除率为86.7%,不良反应发生率为13.3%;万古霉素治疗的临床有效率为80.9%、细菌清除率为75%,不良反应发生率16%.两组临床有效率、细菌清除率及不良反应发生率比较,差异无统计学意义.利奈唑胺和万古霉素均可显著降低血清TNF-α、CRP的水平,两组差异无统计学意义.结论 利奈唑胺治疗老年MRSA肺炎的临床疗效与万古霉素相当,但却无明显肾毒性,对肾功能减退的老年患者可考虑使用利奈唑胺,同时利奈唑胺的不良反应受到关注.     

恶唑烷酮类抗菌药：利奈唑胺

革兰阳性球菌是临床常见致病菌 ,且耐药性上升迅速 ,甲氧西林耐药葡萄球菌、糖肽类耐药肠球菌、青霉素耐药肺炎链球菌所占比例日益上升 ,糖肽类中度敏感葡萄球菌也已出现。据 1998年美国医院感染监测系统资料 ,医院内万古霉素耐药肠球菌分离比例 >2 0 % [1] ,重症监护病房 (ＩＣＵ)中甲氧西林耐药葡萄球菌超过 5 0 %。而对糖肽类抗生素耐药的肠球菌属 ,尤其是屎肠球菌 ,可对临床应用抗菌药均出现耐药 ,感染性疾病的治疗面临严峻的挑战。近年来 ,人们开发了数个新的抗菌药 ,用于耐药革兰阳性菌的治疗。利奈唑胺 (ｌｉｎｅｚｏｌｉｄ)为一类新…     

利奈唑胺致异基因造血干细胞移植后纯红细胞再生障碍性贫血一例报告并文献复习

【目的】探讨利奈唑胺引起异基因造血干细胞移植后纯红细胞再生障碍性贫血（PRCA ）的临床表现、治疗及可能机制。【方法】报道1例异基因造血干细胞移植后应用利奈唑胺引起反复严重贫血,结合文献分析其可能原因。【结果】利奈唑胺可引起 PRCA ,可能与 T 细胞异常增殖有关。【结论】造血干细胞移植后应用利奈唑胺可能引起PRCA ,需密切监测网织红细胞的变化。     

2 527株临床分离病原菌的耐药性分析

目的 分析粤北人民医院临床分离病原菌对常用抗菌药的耐药性,为临床合理使用抗菌药物提供依据。方法 采用K-B法或MIC法对2013年2 527株临床分离株进行药敏试验。以CLSI 2012为判断标准,应用WHONET5.4和SPSS19.0软件进行数据分析,综合分析医院的耐药情况。结果 金黄色葡萄球菌中耐甲氧西林菌株占30.9%,耐甲氧西林凝固酶阴性葡萄球菌的检出率为76.2%,未检出万古霉素、利奈唑胺耐药菌株。屎肠球菌对所测抗菌药物的耐药性显著高于粪肠球菌,屎肠球菌中未检出糖肽类和利奈唑胺耐药菌株,但是粪肠球菌中检出1株利奈唑胺耐药菌株,检出2株替考拉宁耐药菌株。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,大肠埃希菌、肺炎克雷伯菌中产ESBLs株分别为43.9%和37.5%,检出5株对多黏菌素B耐药的铜绿假单胞菌,多重耐药鲍曼不动杆菌占了63.7%。结论 临床病原菌耐药性较严重,应加强监测,临床应依据药敏结果合理的应用抗生素。     

利奈唑胺治疗新生儿化脓性脑膜炎的疗效和安全性

目的探讨利奈唑胺治疗新生儿化脓性脑膜炎的疗效及安全性。方法收集单用或联合使用利奈唑胺治疗的14例化脓性脑膜炎患儿的资料,根据使用利奈唑胺治疗前后患儿的症状、体征、脑脊液检查及细菌培养结果等指标,评价利奈唑胺治疗新生儿化脓性脑膜炎的疗效及安全性。结果 14例化脓性脑膜炎患儿经脑脊液培养明确革兰阳性球菌感染或经前期治疗怀疑合并革兰阳性球菌感染,使用利奈唑胺治疗后的总有效率为92.9%(13/14)。治疗后患儿的体温、脑脊液细胞总数、白细胞计数及脑脊液蛋白质水平均较治疗前降低,脑脊液葡萄糖水平升高(P均<0.05),2例患儿治疗后出现白细胞下降,12例患儿未见利奈唑胺相关不良反应。结论利奈唑胺可有效治疗新生儿革兰阳性球菌所致化脓性脑膜炎,且安全性较高。     

Antibiotics--TAZ/PIPC, synercid, linezolid, everninomicin

The increasing resistance among Gram-positive cocci have been accompanied by their increasing frequency as cause of severe infection. Thus new antimicrobial agents, TAZ/PIPC, synercid and linezolid, are in various stages of development. TAZ/PIPC, a combination drug of a new beta-lactamase inhibitor tazobactam and piperacillin at ratio in 1 to 4 has a broad spectrum of antimicrobial activity. Evidence from randomized clinical trials in adults in Japan has shown that TAZ/PIPC is superior to PIPC as a drug for complicated urinary tract infection. Synercid is a streptogramin antibiotic. The spectrum of activity of synercid is similar to vancomycin. Furthermore, most of E. faecium were susceptible. The efficacy of synercid in clinical trials in patients infected with VREF was 65-70%. Linezolid is a member of the oxazolidinones. The antimicrobial spectrum of linezolid is similar to that of vancomycin. In the US, patients with significant infection caused by resistant Gram-positive organisms(mostly VREF) were treated with linezolid. The efficacy of linezolid was about 75%. The clinical trials for everninomicin had been discontinued because of insufficient clinical data supporting its efficacy and safety.     

Linezolid for the treatment of resistant gram-positive cocci

OBJECTIVE: To provide a comprehensive review of linezolid, the first of a new class of antibiotics, the oxazolidinones. Therapeutic issues regarding the emergence of multidrug-resistant bacteria and a brief history of the oxazolidinones are also discussed. DATA SOURCES: A MEDLINE search (1966-March 2001) was conducted to identify pertinent literature, including preclinical trials, clinical trials, and reviews. Unpublished clinical data, adverse effects, and dosing information were abstracted from product labeling. STUDY SELECTION: Clinical efficacy data were extracted from clinical trials, case reports, and abstracts that mentioned linezolid. Additional information concerning antibiotic resistance, the oxazolidinones, in vitro susceptibility and the pharmacokinetic profile of linezolid also was reviewed. DATA SYNTHESIS: Linezolid exhibits activity against many gram-positive organisms, including vancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus, and penicillin-resistant Streptococcus pneumoniae. Linezolid inhibits bacterial protein synthesis at an early step in translation and is rapidly and completely absorbed from the gastrointestinal tract following oral administration. Efficacy has been demonstrated in a number of unpublished clinical trials in adults with pneumonia, skin and skin structure infections, and vancomycin-resistant E. faecium infections. The adverse effect profile is similar to that of comparator agents (beta-lactams, clarithrornycin, vancomycin). CONCLUSIONS: Linezolid is the first oral antimicrobial agent approved for the treatment of vancomycin-resistant enterococci. Since the oxazoildinones have a unique mechanism of action and expanded spectrum of activity against virulent and highly resistant gram positive pathogens, linezolid is a valuable alternative to currently available treatment options. Clinical trials evaluating linezolid and other oxazolidinones for antibiotic-resistant gram-positive infections, as well as comparator studies comparing linezolid with other candidate drugs, such as quinupristin/dalfopristin and choramphenicol, will further define the role of linezolid.     

Worldwide assessment of linezolid's clinical safety and tolerability: comparator-controlled phase III studies

Linezolid, an oxazolidinone antibiotic, has 100% oral bioavailability and favorable activities against gram-positive pathogens including multidrug-resistant staphylococci, enterococci, and pneumococci. Safety assessments were conducted for 2,046 linezolid-treated patients and 2,001 comparator drug-treated patients from seven controlled clinical trials comparing the activities of linezolid and comparator drugs against nosocomial and community-acquired pneumonia, skin and skin structure infections, and methicillin-resistant staphylococcal infections. Drug-related adverse events were primarily transient. The most frequent (> or = 2%) adverse events caused by linezolid and the comparator drugs were diarrhea (4.3 and 3.2%, respectively; P = 0.074), nausea (3.4 and 2.3%, respectively; P = 0.036), and headache (2.2 and 1.3%, respectively; P = 0.047). Treatment discontinuations due to drug-related events (2.4 and 1.9%, respectively), serious adverse events (11.4 and 10.6%, respectively), and deaths (4.8 and 4.9%, respectively) were similar. No clinically significant drug-related hematologic events were reported, and laboratory safety data were comparable. In the first 6 months of postmarketing surveillance, hematologic abnormalities were reported in 0.1% of linezolid-treated patients, but no irreversible blood dyscrasias were documented. The risk for transient, reversible hematologic effects from treatment with linezolid should be considered together with the clinical benefits associated with its use.     

Systematic Review and Meta-Analysis To Estimate Antibacterial Treatment Effect in Acute Bacterial Skin and Skin Structure Infection

A systematic literature review and meta-analysis were conducted to estimate the antibacterial treatment effect for linezolid and ceftaroline to inform on the design of acute bacterial skin and skin structure infection (ABSSSI) noninferiority trials. The primary endpoints included an early clinical treatment response (ECTR) defined as cessation of lesion spread at 48 to 72 h postrandomization and the test-of-cure (TOC) response defined as total resolution of the infection at 7 to 14 days posttreatment. The systematic review identified no placebo-controlled trials in ABSSSI, 4 placebo-controlled trials in uncomplicated skin and soft tissue infection as a proxy for placebo in ABSSSI, 12 linezolid trials in ABSSSI, 3 ceftaroline trials in ABSSSI, and 2 trials for nonantibacterial treatment. The ECTR rates at 48 to 72 h and corresponding 95% confidence intervals (CI) were 78.7% (95% CI, 61.1 to 96.3%) for linezolid, 74.0% (95% CI, 69.7 to 78.3%) for ceftaroline, and 59.0% (95% CI, 52.8 to 65.3%) for nonantibacterial treatment. The early clinical treatment effect could not be estimated, given no available placebo or proxy for placebo data for this endpoint. Clinical, methodological, and statistical heterogeneity influenced the selection of trials for the meta-analysis of the TOC treatment effect estimation. The pooled estimates of the TOC treatment response were 31.0% (95% CI, 6.2 to 55.9%) for the proxy for placebo, 88.1% (95% CI, 81.0 to 95.1%) for linezolid, and 86.1% (95% CI, 83.7 to 88.6%) for ceftaroline. The TOC clinical treatment effect estimation was 25.1% for linezolid and 27.8% for ceftaroline. The antibacterial treatment effect estimation at TOC will inform on the design and analysis of future noninferiority ABSSSI clinical trials.     

利奈唑胺与替考拉宁比较治疗耐甲氧西林金黄色葡萄球菌肺炎的Meta分析

目的系统评价利奈唑胺与替考拉宁比较治疗耐甲氧西林金黄色葡萄球菌肺炎的疗效和安全性。方法计算机检索CBM、CNKI、WanFangData、VIP、ScienceDirect、PubMed、Ovid、SciFinder、The Cocharane Library（2013年第3期）和EMbase数据库．收集2003年1月～2013年3月国内外公开发表的关于利奈唑胺和替考拉宁比较治疗耐甲氧西林金黄色葡萄球菌肺炎的临床疗效和安全性的随tJLx,~照试验或两组均衡可比、非随机的前瞻性研究。按Cochrane系统评价方法，南2位研究者独立筛选文献、提取资料并评价质量后，采用RevMan5．2软件进行Meta分析。结果最终纳入7个研究，包括637例患者。Meta分析结果显示，有效率[RR=1．17，95％CI（1．04．1．32），P=0．009]、痊愈率[RR=1．06，95％CI（0．94，1．19），P=0．37]、细菌清除率[RR=1．32，5％CI（1．03，1．68），P；0．03]和不良反应发生率[RR=I．24，95％CI（0．78，1．97），P=0．37]，经Begg检验和Egger检验，P值均〉0．05。结论现有证据湿示，利奈唑胺在治疗耐甲氧西林金黄色葡萄球菌患者的临床有效率和细菌清除率优于替考拉宁，在痊愈率和不良反应发生率方面，两者无明显差异。     

Linezolid for treatment of ventilator-associated pneumonia: a cost-effective alternative to vancomycin

OBJECTIVES: To determine the incremental cost-effectiveness of linezolid compared with vancomycin for treatment of ventilator-associated pneumonia due to Staphylococcus aureus. DESIGN: Decision model analysis of the cost and efficacy of linezolid vs. vancomycin for treatment of ventilator-associated pneumonia. The primary outcome was the incremental cost-effectiveness of linezolid in terms of cost per added quality-adjusted life-year gained. Other outcomes were the marginal costs per hospital survivor and per year of life saved generated by using linezolid. Model estimates were derived from prospective trials of linezolid for ventilator-associated pneumonia and from other studies describing the costs and outcomes for ventilator-associated pneumonia. SETTING AND PATIENTS: Hypothetical cohort of 1,000 patients diagnosed with ventilator-associated pneumonia. INTERVENTIONS: In the model, patients received either linezolid or vancomycin. MEASUREMENTS AND MAIN RESULTS: The incremental cost-effectiveness of linezolid was calculated as the additional quality-adjusted life-years resulting from therapy with linezolid divided by the sum of the incremental costs arising because of use of linezolid (e.g., higher direct costs for linezolid, costs per in-hospital care of survivors, and posthospitalization costs). Despite its higher cost, linezolid was cost-effective for treatment of ventilator-associated pneumonia. The cost per quality-adjusted life-year equals approximately 30,000 dollars. The model was moderately sensitive to the estimated efficacy of linezolid over vancomycin. Nonetheless, even with all inputs simultaneously skewed against, linezolid remains a cost-effective option (cost per quality-adjusted life-year approximately 100,000 dollars). Based on Monte Carlo simulation, the results of our analysis are robust across a range of model inputs and assumptions (95% confidence interval for cost per quality-adjusted life-year ranges from 23,637 dollars to 42,785 dollars). CONCLUSIONS: Linezolid is a cost-effective alternative to vancomycin for the treatment of ventilator-associated pneumonia.     

《中国临床药理学杂志》随机对照临床试验文献方法学评价

目的：评价《中国临床药理学杂志》临床治疗随机对照试验论文的设计和撰写现状。方法：逐期逐页人工检索《中国临床药理学杂志》1985（创刊）－2000年中发表的临床治疗试验，根据Cochrane中心手检指南对其中的RCT和CCT进行严格鉴定。结果：16卷68期共刊登临床研究论文166篇，其中RCT34篇，占20．5％，CCT95篇,57．2％。结论：《中国临床药理学杂志》临床治疗随机对照试验论文数呈逐年增加，但也存在一些问题，其质量仍有待提高。     

《中国实用眼科杂志》随机对照临床治疗试验文献方法学评价

目的：了解《中国实用眼科杂志》从1983年至2000年间随机对照临床治疗试验论文的设计和撰写现状。方法：逐期逐页手工检索《中国实用眼科杂志》1983－2000年中发表的对照试验论文，按Cochrane协作网RCT、CCT资料库中的判定标准进行严格鉴定。结果：在18卷194期中共刊登临床对照试验166篇（其中RC178篇，CCT8篇）。结论：《中国实用眼科杂志》刊登的临床随机对照试验论文逐年增多，但仍存在较多问题：没有做到真正的随机，试验组和对照组基线资料缺乏可比性，样本量太少，纳入、排除标准不明确，没有恰当的统计学分析。临床治疗试验的设计多采用RCT和盲法，并做到真正的随机。     

Action of linezolid or vancomycin on biofilms in ventriculoperitoneal shunts in vitro

Cerebrospinal fluid (CSF) shunts used to treat hydrocephalus have an overall infection rate of about 10% of operations. The commonest causative bacteria are Staphylococcus epidermidis, followed by Staphylococcus aureus and enterococci. Major difficulties are encountered with nonsurgical treatment due to biofilm development in the shunt tubing and inability to achieve sufficiently high CSF drug levels by intravenous administration. Recently, three cases of S. epidermidis CSF shunt infection have been treated by intravenous linezolid without surgical shunt removal, and we therefore investigated vancomycin and linezolid against biofilms of these bacteria in vitro. A continuous-perfusion model of shunt catheter biofilms was used to establish mature (1-week) biofilms of Staphylococcus aureus, Staphylococcus epidermidis (both methicillin resistant [MRSA and MRSE]), Enterococcus faecalis, and Enterococcus faecium. They were then "treated" with either vancomycin or linezolid in concentrations achievable in CSF for 14 days. The biofilms were then monitored for 1 week for eradication and for regrowth. Enterococcal biofilms were not eradicated by either vancomycin or linezolid. Staphylococcal biofilms were eradicated by both antibiotics after 2 days and did not regrow. No resistance was seen. Linezolid at concentrations achievable by intravenous or oral administration was able to eradicate biofilms of both S. epidermidis (MRSE) and S. aureus (MRSA). Neither vancomycin at concentrations achievable by intrathecal administration nor linezolid was able to eradicate enterococcal biofilms. It is hoped that these in vitro results will stimulate further clinical trials with linezolid, avoiding surgical shunt removal.