Efficacy and safety of linezolid for Gram-positive orthopedic infections: a prospective case series

Linezolid is an attractive alternative for orthopedic infections because of oral bioavailability and activity against methicillin-resistant staphylococci and vancomycin-resistant enterococci. To determine efficacy and safety, we prospectively monitored 51 consecutive adults who were not vancomycin candidates and who received linezolid for 53 Gram-positive orthopedic infections, usually chronic osteomyelitis (n = 25) or prosthetic joint infection (n = 23). Pathogens were usually Staphylococcus aureus (n = 27) or coagulase-negative staphylococci (n = 19); 38 were methicillin resistant. After remission, 17 infections required long-term suppression, usually because of retained hardware. Clinical and microbiologic failure occurred in only one patient. The most common adverse events were thrombocytopenia (n = 5) and anemia (n = 5), necessitating treatment discontinuation in 3 patients. One patient developed reversible optic and irreversible peripheral neuropathy after 24 months of linezolid. Linezolid, with surgery, may be a reasonable alternative for Gram-positive orthopedic infections. We recommend weekly hematologic monitoring, and, if therapy lasts >2 months, periodic ophthalmologic monitoring.