Response rates determined by clearance of S. aureus from follow-up surveillance BAL.
From March 2002 to October 2003, thirteen lung transplant recipients (8 bilateral, 4 single, 1 bilateral lobar) (7 cystic fibrosis, 3 interstitial lung disease, 3 emphysema) received linezolid treatment (mean 816 ± 1068 days post-transplant) for S. aureus (10 methicillin-resistant, 3 methicillin-susceptible), isolated from bronchoalveolar lavage (BAL). Response rates were determined by clearance of S. aureus from follow-up surveillance BAL.
Resolution of infection occurred in 7/13 patients (54%) within 36.3 ± 29.8 days of treatment. Lung function measured by FEV1 improved from pre-treatment values of 1.69L ± 0.65 to 1.83L ± 0.64. Of the three patients having biopsy-proven pneumonia or acute bronchitis, all had complete histologic amelioration. Of the patients that had persistent S. aureus colonization, 5/6 (83%) had chronic airways disease, including bronchiectasis and/or fibrotic airway strictures. Linezolid was tolerated well and did not cause thrombocytopenia or liver function test abnormalities.
Linezolid appears to be effective for S. aureus broncho-pulmonary infections after lung transplantation.
Due to availability in oral formulation, linezolid may offer a significant advantage compared to intravenous antibiotic preparations. Inhalational delivery of linezolid should be explored for patients with chronic airways disease who fail systemic therapy.
M.M. Crespo, None.