Hill David M, Wood G Christopher, Hickerson William L
Regional One Health, Memphis, TN, USA
University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA.
Ann Pharmacother. 2015 Feb;49(2):250-3. doi: 10.1177/1060028014563066. Epub 2014 Dec 16.
To describe the first reported successful use of adjunctive linezolid bladder irrigation.
An 89-year-old woman with 10% TBSA burns developed septic shock and anuric acute kidney insufficiency. She acquired a urinary tract infection caused by vancomycin-resistant Enterococcus faecium (VREfm). Based on clinical status, a linezolid bladder irrigation was initiated in addition to high-dose intravenous linezolid and demonstrated microbiological cure with 7 days of treatment.
Linezolid is primarily hepatically cleared and has no labeled indication for urinary tract infections. Anuria adds an additional complication of potentially reduced urinary drug concentrations. Bladder irrigation offers the benefit of achieving high local drug concentrations, but there are no data regarding such a route for linezolid. This case report is the first demonstrating the use, stability, safety, and efficacy of linezolid as a continuous bladder irrigation.
Linezolid use as a bladder irrigation may be a feasible route of administration in anuric, critically ill patients with VREfm and few antimicrobial options. Further studies are warranted.
描述首次报道的辅助性利奈唑胺膀胱冲洗的成功应用。
一名89岁女性，烧伤面积达10%体表面积，发生感染性休克和无尿性急性肾功能不全。她感染了耐万古霉素屎肠球菌（VREfm）引起的尿路感染。基于临床状况，除了大剂量静脉注射利奈唑胺外，还开始进行利奈唑胺膀胱冲洗，治疗7天后显示微生物学治愈。
利奈唑胺主要经肝脏清除，且未被标记用于尿路感染。无尿增加了尿药浓度可能降低的额外并发症。膀胱冲洗具有实现高局部药物浓度的益处，但尚无关于利奈唑胺这种给药途径的数据。本病例报告首次证明了利奈唑胺作为持续膀胱冲洗的应用、稳定性、安全性和有效性。
对于无尿的、患有VREfm且抗菌药物选择有限的重症患者，利奈唑胺用作膀胱冲洗可能是一种可行的给药途径。有必要进行进一步研究。
