Bassetti Matteo, Righi Elda, Di Biagio Antonio, Rosso Raffaella, Beltrame Andrea, Bassetti Dante
A.O. Ospedale Università San Martino di Genova, Clinica Malattie Infettive, Largo R. Benzi 1016132 Genova, Italy.
Expert Rev Anti Infect Ther. 2005 Jun;3(3):343-52. doi: 10.1586/14787210.3.3.343.
Gram-positive organisms, particularly staphylococci and streptococci, are responsible for the majority of bone and joint infections. The rising incidence of antimicrobial resistance among Staphylococcus aureus, coagulase-negative staphylococci and enterococci means that novel antibiotics with unique mechanisms of antimicrobial activity are needed, especially in orthopedic infections. Linezolid is the first of the oxazolidinones, a new class of antibacterial agents particularly effective against Gram-positive infections including methicillin- and vancomycin-resistant strains. With an excellent oral bioavailability and acceptable safety profile, linezolid offers a valuable alternative to more traditional therapies, such as glycopeptides. No large randomized trials have been published on its use in patients with orthopedic infections, but early results are encouraging. Reported adverse events, especially bone marrow suppression and optic neuropathy seen with prolonged administration, mean that treatment of such patients must be undertaken with careful follow-up of laboratory tests. Until now, little resistance has been reported.
革兰氏阳性菌,尤其是葡萄球菌和链球菌,是大多数骨和关节感染的致病菌。金黄色葡萄球菌、凝固酶阴性葡萄球菌和肠球菌对抗菌药物耐药性的不断上升意味着需要具有独特抗菌活性机制的新型抗生素,尤其是在骨科感染中。利奈唑胺是恶唑烷酮类药物中的首个药物,这是一类新型抗菌剂,对革兰氏阳性菌感染特别有效,包括耐甲氧西林和耐万古霉素菌株。利奈唑胺具有出色的口服生物利用度和可接受的安全性,为更传统的疗法(如糖肽类)提供了有价值的替代方案。尚未有关于其在骨科感染患者中使用的大型随机试验发表,但早期结果令人鼓舞。报告的不良事件,尤其是长期给药时出现的骨髓抑制和视神经病变,意味着对此类患者的治疗必须在仔细随访实验室检查的情况下进行。到目前为止,几乎没有耐药性的报道。