Linezolid in the treatment of HIV-infected patients with complicated skin and soft tissue infections

Introduction

The incidence of HIV-infected patients with complicated skin and soft tissue infections has risen. Because of advanced immune suppression, slower responses to antibacterial treatment, and increased risk of bacteraemia relative to noninfected patients, the choice of initial appropriate empiric antibacterial therapy is an important aspect of care for HIV-infected patients. However, in recent years a dramatic increase of the resistance among Staphylococci to all classes of antimicrobial agents, including glycopeptides, has been reported.

Patients and methods

We studied 146 patients with skin and soft tissue infections co-infected by HIV and 72 noninfected patients with soft tissue infections aged 18–45 years. All of the patients underwent operations aimed at surgical removal of the dead tissues and pus and received different combinations of antibacterial agents. Twenty-three patients after adequate surgery received Linezolid in doses of 600 mg twice a day intravenously during 3–4 days with oral follow-up of 600 mg twice a day.

Results

The most frequent pathogens are Staphylococci in both groups of patients with soft tissue infections: 56% was noted among the noninfected patients and 61% among the HIV-infected patients. MRSA was identified in 30% of Staphylococci in HIV-infected patients. Among the patients receiving Linezolid, MRSA was identified in nine cases; in two cases vancomycin-intermediate S. aureus strains, and in one case vancomycin-resistant S. aureus strain. In three cases we revealed Staphylococcus bacteraemia, in one case MRSA bacteraemia in patient with retroperitoneal phlegmon.

A statistical difference was identified in duration of high temperature, purulence and wound healing in comparison with patients receiving different combinations of antibacterial agents. All patients receiving Linezolid were discharged from the hospital. The length of stay was 17 ± 1.67 days in comparison with patients receiving other antibacterial agents (from 19.52 ± 1.37 to 20.3 ± 1.46 days). The length of stay in hospital among the noninfected patients with soft tissue infection was 9.5 days. Modification of antibacterial treatment was not required in the group of patients receiving Linezolid. No significant laboratory abnormalities and side effects were noted. We did not reveal statistical differences in the platelet count in group of patients receiving Linezolid (5 days after operation 213 ± 26.0/mm³) in comparison with the group receiving other antibacterial agents (256 ± 32/mm³). Thrompocytopenia is characterized to HIV-infected patients, but did not deteriorate in patients receiving Linezolid

Conclusion

Linezolid in the complex treatment of HIV-infected patients with complicated skin and soft tissue infections may improve the results of therapy and may be used for initial empirical intravenous-to-oral antibacterial therapy.