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Muñoz P, De la Villa S, Martínez-Sellés M, Goenaga MA, Reviejo-Jaka K, Revillas FADL, García-Cuello L, Hidalgo-Tenorio C, Rodríguez-Esteban MA, Antorrena I, Castelo-Corral L, García-Vázquez E, De la Torre J, Bouza E. Linezolid for infective endocarditis: A structured approach based on a national database experience. Medicine (Baltimore) 2021; 100:e27597. [PMID: 34941026 PMCID: PMC8701757 DOI: 10.1097/md.0000000000027597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/06/2021] [Indexed: 01/05/2023] Open
Abstract
Current data on the frequency and efficacy of linezolid (LNZ) in infective endocarditis (IE) are based on small retrospective series. We used a national database to evaluate the effectiveness of LNZ in IE.This is a retrospective study of IE patients in the Spanish GAMES database who received LNZ. We defined 3 levels of therapeutic impact: LNZ < 7 days, LNZ high-impact (≥ 7 days, > 50% of the total treatment, and > 50% of the LNZ doses prescribed in the first weeks of treatment), and LNZ ≥ 7 days not fulfilling the high-impact criteria (LNZ-NHI). Effectiveness of LNZ was assessed using propensity score matching and multivariate analysis of high-impact cases in comparison to patients not treated with LNZ from the GAMES database matched for age-adjusted comorbidity Charlson index, heart failure, renal failure, prosthetic and intracardiac IE device, left-sided IE, and Staphylococcus aureus. Primary outcomes were in-hospital mortality and one-year mortality. Secondary outcomes included IE complications and relapses.From 3467 patients included in the GAMES database, 295 (8.5%) received LNZ. After excluding 3 patients, 292 were grouped as follows for the analyses: 99 (33.9%) patients in LNZ < 7 days, 11 (3.7%) in LNZ high-impact, and 178 (61%) in LNZ-NHI. In-hospital mortality was 51.5%, 54.4%, and 19.1% respectively. In the propensity analysis, LNZ high-impact group presented with respect to matched controls not treated with LNZ higher in-hospital mortality (54.5% vs 18.2%, P = .04). The multivariate analysis showed an independent relationship of LNZ use with in-hospital mortality (odds ratio 9.06, 95% confidence interval 1.15--71.08, P = .03).Treatment with LNZ is relatively frequent, but most cases do not fulfill our high-impact criteria. Our data suggest that the use of LNZ as definitive treatment in IE may be associated with higher in-hospital mortality.
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Affiliation(s)
- P Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - S De la Villa
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - M A Goenaga
- Servicio de Enfermedades Infecciosas. Hospital Universitario Donosti, San Sebastián
| | - K Reviejo-Jaka
- Servicio de Medicina Intensiva. Policlínica-Grupo Quirón Gipuzkoa, San Sebastián, Spain
| | - F Arnáiz de Las Revillas
- Servicio de Enfermedades Infecciosas. Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria, Santander, Spain
| | - L García-Cuello
- Servicio de Enfermedades Infecciosas. Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria, Santander, Spain
| | - C Hidalgo-Tenorio
- Unidad de Gestión Clínica de Enfermedades Infecciosas. Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M A Rodríguez-Esteban
- Unidad de Cuidados Intensivos Cardiológicos. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - I Antorrena
- Servicio de Cardiología. Hospital Universitario La Paz, Madrid, Spain
| | - L Castelo-Corral
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - E García-Vázquez
- Servicio de Medicina Interna-Infecciosas. IMIB. Hospital Clínico Universitario Virgen de la Arrixaca. Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - J De la Torre
- Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna. Hospital Costa del Sol, Málaga, Spain
| | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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