Use of linezolid in a high complexity hospital of Bogotá city

Abstract

Introduction: Studying the prescription of last generation antibiotics helps to identify the causes and consequences of the inadequate use of antibiotics. These include the appearance of antibacterial resistance, a situation declared by the WHO as a global public health problem. Aim: To describe the prescription of linezolid in a high complexity hospital in Bogotá, Colombia,considering the follow-up of the recommendations for the use of the drug included in clinical practice guidelines (CPG) and its indications. Methods: A descriptive observational study of longitudinal section was performed with retrospective collection of the information of all patients who were prescribed linezolid, at a minimum dose of 600 mg every 12 h during their hospitalization in the period from January 1st, 2017, to December 31st, 2018. The characteristics of linezolid prescription were described. Results: 133 prescriptions were reviewed. The most frequently diagnosed were sepsis of different origin (pulmonary abdominal, urinary) with 22.6 % (30/133), followed by skin and soft tissue infection 16.5 % (22/133), the pneumonia with 12.8 % (17/133) and urinary tract infections with 9.8 % (13/133). Two days treatment was the most frequent (range 1-30 days). In 33 % (44/133) of the patients, linezolid was used empirically (without using a previous antibiotic), while in 40.6 % (54/133) it was used as a second option (a previous antibiotic scheme). It was used as a third option in 20.3 % (27/133). Finally, in 6 % (8/133) of the patients, linezolid was prescribed after three previous antibiotics. It was necessary to use another antibiotic in near fifty percent of patients because linezolid did not work. Conclusions: The present study shows that there is little adherence to the institutional CPGs in relation to the treatment time, the microorganism identification, and the use as first option. The absence of a full-time infectious disease specialist, the high workload and the continuous rotation of prescribing staff may be the causeof these results. Some cases of inappropriate use may be related to the clinicalcondition of the patient which requires empirical treatments.