Oral switch to linezolid is a promising alternative to standard parenteral therapy (SPT) in Staphylococcus aureus bacteremia (SAB).
We conducted a prospective cohort study of all adult cases of SAB between 2013 and 2017 in a Spanish University Hospital. We compared the efﬁcacy, safety, and length of hospital stay of patients receiving SPT and those where SPT was switched to oral linezolid from day 3 to 9 of treatment until completion. We excluded complicated SAB and osteoarticular infections. A k-nearest neighbor algorithm was used for propensity score matching with a 2:1 ratio.
After propensity score matching we included 45 patients of the linezolid group and 90 patients of the SPT group. Leading SAB-sources were catheter-related (49.6%), unknown origin (20.0%), and skin and soft tissue (17.0%). Patients in the linezolid group had less chronic renal disease (4.4% vs 22.2%). We observed no difference in 90-day relapse between the linezolid group and the SPT group (2.2% vs 4.4% respectively; P=0.87). No statistically significant difference was observed in 30-day all-cause mortality between the linezolid group and the SPT group (2.2% vs 13.3%; P=0.08). The median length of hospital stay after onset was 8 days in the linezolid group and 19 days in the SPT group (P<0.01). No drug-related events leading to discontinuation were noted in the linezolid group.
Treatment of SAB in selected low-risk patients with an oral switch to linezolid from day 3 to 9 of treatment until completion yielded similar clinical outcomes as SPT, allowing earlier discharge from the hospital.