Early Switch From Vancomycin to Oral Linezolid for Treatment of Gram-Positive Heart Valve Endocarditis

doi:10.1016/j.athoracsur.2007.02.096

The Annals of Thoracic Surgery

Volume 84, Issue 1, July 2007, Pages 87-91

https://doi.org/10.1016/j.athoracsur.2007.02.096 Get rights and content

Background

Patients with complicated gram-positive endocarditis are usually treated with a combination of surgical procedure and long-term antibiotic therapy with intravenous vancomycin. However, oral linezolid offers the potential for an early switch from intravenous vancomycin to oral linezolid therapy.

Methods

We conducted a retrospective study from February 2002 to August 2005 to determine the potential for early switch from intravenous vancomycin to oral linezolid in patients surgically treated for a left-sided active gram-positive endocarditis.

Results

Fourteen patients were identified; average age was 52 ± 16 years. There were 10 (85%) and 2 (15%) cases of native and prosthetic valve endocarditis, respectively. Patients were operated on 3 to 10 days after diagnosis. There were no cases of operative mortality. Mean follow-up was 20.8 ± 7.0 months. Two (14%) patients died of noncardiac causes during follow-up. The mean intensive care unit length of stay was 3.1 ± 2.3 days, and mean hospital length of stay was 10.5 ± 3.4 days. No cases of recurrent endocarditis or periprosthetic leakage were observed.

Conclusions

The combination of aggressive surgical treatment and the early switch from intravenous vancomycin to oral linezolid for treatment of active gram-positive heart valve endocarditis is safe and effective, and reduces infection relapses, vancomycin use, hospital length of stay, and economic costs.

Section snippets

Material and Methods

This study was conducted in agreement with the revised Declaration of Helsinki. The institutional review board approved the protocol, and all patients provided written informed consent. A retrospective analysis of the hospital database was performed during February 2002 through August 2005 after the introduction of linezolid at our institution. All patients presenting with active native or prosthetic valve left-sided endocarditis caused by resistant gram-positive bacteria who underwent surgical

Results

During the study period, 14 patients were surgically treated for left-sided active endocarditis. There were 10 male and 4 female patients, and the mean age was 52 ± 16 years. Ten patients were admitted with New York Heart Association class III criteria, and 4 patients satisfied New York Heart Association class IV criteria. Four patients were admitted directly to the intensive care unit, and of these, 3 were already receiving mechanical ventilation. Four patients presented with renal failure

Comment

Surgical treatment of active infective endocarditis by valve replacement or repair still remains a challenge to physicians because it requires a surgically demanding operation and special emphasis on the eradication of the infectious focus to prevent early postoperative prosthesis colonization. This goal can be achieved by combining aggressive debridement of infective tissue and appropriate postoperative antibiotic treatment.

The prevalence of antibiotic resistance is increasing in many

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Original articleCardiovascularEarly Switch From Vancomycin to Oral Linezolid for Treatment of Gram-Positive Heart Valve Endocarditis

Background

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

Lancet

Infect Dis Clinic N Am

Curr Opin Pharmacol

Clin Therap

Clin Ther

Mayo Clin Proc

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Emergence of vancomycin resistance in Staphylococcus aureus

N Engl J Med

Vancomycin resistance in staphylococci

Clin Microbiol Rev

Staphylococcus aureus resistance to vancomycin—United States, 2002

MMWR Morb Mortal Wkly Rep

The economic impact of Staphylococcus aureus infection in New York City hospitals

Emerging Infect Dis

Control of methicillin-resistant Staphylococcus aureus in the hospital setting

Am J Med

Bacteremic pneumonia due to Staphylococcus aureus: a comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms

Clin Infect Dis

The oxazolidinone linezolid inhibits initiation of protein synthesis in bacteria

Antimicrob Agents Chemother

Linezolid

Drugs

Early switch from intravenous to oral antibiotics: guidelines and implementation in a large teaching hospital

J Antimicrob Chemother

Original article
Cardiovascular
Early Switch From Vancomycin to Oral Linezolid for Treatment of Gram-Positive Heart Valve Endocarditis