Akter Fahima, Bozell Hannah, Neumann Tyson, Chung Cheng
Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, USA.
Pediatrics, Albany Medical Center, Albany, USA.
Cureus. 2024 Oct 3;16(10):e70794. doi: 10.7759/cureus.70794. eCollection 2024 Oct.
Linezolid has gained increased use for the treatment of infections caused by multidrug-resistant Gram-positive bacteria in recent years. It can cause rare but potentially life-threatening lactic acidosis. Here, we presented a case report of linezolid-induced lactic acidosis (LILA), along with a systematic review of current literature. The patient was a 55-year-old male who presented with the symptoms of acute cholecystitis. He had been treated for sepsis due to acute cholecystitis with broad-spectrum antibiotics and intravenous fluids as per protocol. Still, his lactate level was getting elevated. After excluding other causes of lactic acidosis, LILA was diagnosed, and linezolid was discontinued. His lactic acid level, as well as his physical condition, improved after that. Studies related to LILA were searched in Medline via PubMed. After screening titles, abstracts, and full texts, data were extracted, tabulated, and presented in this article. The risk of bias was also assessed. We found 78 relevant articles in the primary search, and 26 articles, including 496 patients, were included in the study. From 23 studies of 129 patients, 28 patients (21.7%) died in the setting of LILA. The peak lactate level in which the patient developed LILA was 38.1 mmol/L after four weeks of therapy. The most common health conditions associated with LILA were end-stage renal failure (ESRD), diabetes mellitus (DM), hypertension, chronic obstructive pulmonary disease (COPD), etc. Eighteen studies with a total of 30 patients discontinued it after the development of LILA. Twenty-four patients (80%) out of 30 survived after the discontinuation. We recommend including LILA in the differential diagnoses when treating patients with lactic acidosis since LILA is associated with a relatively elevated mortality rate.
近年来，利奈唑胺在治疗耐多药革兰氏阳性菌引起的感染方面应用日益广泛。它可导致罕见但可能危及生命的乳酸酸中毒。在此，我们报告一例利奈唑胺诱发的乳酸酸中毒（LILA）病例，并对当前文献进行系统综述。患者为一名55岁男性，出现急性胆囊炎症状。他已按照方案接受了针对急性胆囊炎所致败血症的广谱抗生素和静脉输液治疗。然而，他的乳酸水平仍在升高。在排除乳酸酸中毒的其他原因后，诊断为LILA，并停用了利奈唑胺。此后，他的乳酸水平以及身体状况均有所改善。通过PubMed在Medline中检索与LILA相关的研究。在筛选标题、摘要和全文后，提取数据、制表并在本文中呈现。还评估了偏倚风险。我们在初步检索中发现78篇相关文章，本研究纳入了26篇文章，包括496例患者。在129例患者的23项研究中，28例（21.7%）在LILA情况下死亡。患者发生LILA时的乳酸峰值水平在治疗四周后为38.1 mmol/L。与LILA相关的最常见健康状况为终末期肾衰竭（ESRD）、糖尿病（DM）、高血压、慢性阻塞性肺疾病（COPD）等。18项研究共30例患者在发生LILA后停用了该药物。30例患者中有24例（80%）在停药后存活。我们建议在治疗乳酸酸中毒患者时将LILA纳入鉴别诊断，因为LILA与相对较高的死亡率相关。
