Preliminary exploration of the therapeutic effect of linezolid replacing vancomycin on intracranial bacterial infections

Objective To analyze the efficacy and safety of linezolid (LZD) on patients suffering from intracranial bacterial infection with suspected resistance to vancomycin, and to provide some references for modifying the clinical strategy in the treatment of the intracranial bacterial infection. Methods A prospective study was conducted from August 2015 to September 2016, into which a total of 11 inpatients were enrolled who suffered from intracranial bacterial (gram positive cocci as suspected pathogen) infection, responded poorly to vancomycin (≥7 days) and were alternatively treated with LZD ( 600 mg twice daily, i. v.) at the Neurosurgical Intensive Care Unit (NICU) of Tianjin Medical University General Hospital. The treatment efficacy and safety using LZD were evaluated. Results Among the 11 cases, 10 were cured and 1 died. Patients were treated with LZD for an average of 22.3±5.3 days. After LZD treatment, 5 cases showed abnormal decreases in multiple parameters of blood routine test, and among them 1 died and the other 4 cases recovered to normal levels after the end of LZD treatment. The median age of the 5 patients with abnormal blood test results was 60 (QR: 21.5) years, which was significantly higher than the median age [33 (QR: 20)] of patients whose blood examination revealed normal (P=0.017). Persistent abnormalities in blood routine test or other related adverse reactions of LZD was not observed during follow-up. Conclusion With close monitoring of blood routine test results, LZD might be used as an alternative to treat intracranial bacterial (gram positive cocci) infection resistant to vancomycin. Key words: Central nervous system bacterial infections; Gram-positive cocci; Vancomycin resistance; Linezolid