<p>Evidence on the timing and burden of haematological adverse events with intravenous linezolid in children remains limited. We retrospectively evaluated paediatric inpatients aged 1 month and 18 years who received ≥ 3 days of IV linezolid at a tertiary children’s hospital (September 2019–December 2022). Primary outcomes were anaemia and thrombocytopenia, defined a priori. Among 261 patients (median age, 6.9 years), 48.3% were treated in the PICU, and 39.1% had haematology–oncology disorders; the median treatment duration was 14 days. Anaemia (56.7%) and thrombocytopenia (41.8%) were the most common conditions, typically occurring in the first week. In multivariable models, anaemia was associated with concomitant myelotoxic drugs, prior exposure to glycopeptides, and concurrent thrombocytopenia; thrombocytopenia was associated with longer treatment duration and concurrent anaemia. Age-stratified analyses revealed similar early onset (median 6–7 days) across strata, with a higher frequency of thrombocytopenia in the youngest group, paralleling the more frequent concomitant use of myelotoxic therapy. In a restricted cohort excluding chemotherapy/HSCT and any myelotoxic agent (including meropenem), event rates declined while the early-onset pattern persisted. Analyses by treatment-duration categories (≤ 10, 11–14, ≥ 15 days) in patients with normal renal/hepatic function suggested a later onset of thrombocytopenia in the ≥ 15-day group; this subgroup also had the lowest rates of myelotoxic co-therapy, haematology–oncology comorbidity, and PICU admission, warranting cautious interpretation. <i>Conclusions</i>: IV linezolid was frequently associated with early haematological toxicity, amplified by concomitant myelotoxic therapy. Sensitivity and exposure–proxy analyses support the robustness of the signal but highlight residual confounding; prospective studies with exposure monitoring are needed to establish causality. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> <p>What is Known:</p> <p>• In children, haematological adverse events are the most frequent toxicities of linezolid; thrombocytopenia is typically reported after week 1.</p> <p>• Paediatric evidence is limited and often confounded by concomitant myelotoxic therapies</p> </entry> </row> <row> <entry nameend="c2" namest="c1"> <p>What is New:</p> <p>• In paediatric inpatients on IV linezolid, anaemia and thrombocytopenia often occur in week 1, with anaemia prominent when myelotoxic co-therapy or prior glycopeptides are present.</p> <p>• In a restricted cohort excluding myelotoxic co-therapy/chemotherapy, event rates declined, yet early onset persisted, supporting robustness beyond confounding.</p> </entry> </row> </tbody> </tgroup> </Table></p>

Clinical use and safety profile of intravenous linezolid in hospitalised children: A retrospective cohort experience

期刊论文
发表日期：

2025年10月20日

查看全文

Ömer Güneş,
Aslınur Özkaya-Parlakay,
Ahmet Yasin Güney,
Fatih Üçkardeş,
Zehra Nihan Coşkun,
Selin Yıldız,
Aysun Yahşi,
Seval Özen,
Tuğba Erat,
Saliha Kanık-Yüksek,
Belgin Gülhan,
Gülsüm İclal Bayhan

摘要

Evidence on the timing and burden of haematological adverse events with intravenous linezolid in children remains limited. We retrospectively evaluated paediatric inpatients aged 1 month and 18 years who received ≥ 3 days of IV linezolid at a tertiary children’s hospital (September 2019–December 2022). Primary outcomes were anaemia and thrombocytopenia, defined a priori. Among 261 patients (median age, 6.9 years), 48.3% were treated in the PICU, and 39.1% had haematology–oncology disorders; the median treatment duration was 14 days. Anaemia (56.7%) and thrombocytopenia (41.8%) were the most common conditions, typically occurring in the first week. In multivariable models, anaemia was associated with concomitant myelotoxic drugs, prior exposure to glycopeptides, and concurrent thrombocytopenia; thrombocytopenia was associated with longer treatment duration and concurrent anaemia. Age-stratified analyses revealed similar early onset (median 6–7 days) across strata, with a higher frequency of thrombocytopenia in the youngest group, paralleling the more frequent concomitant use of myelotoxic therapy. In a restricted cohort excluding chemotherapy/HSCT and any myelotoxic agent (including meropenem), event rates declined while the early-onset pattern persisted. Analyses by treatment-duration categories (≤ 10, 11–14, ≥ 15 days) in patients with normal renal/hepatic function suggested a later onset of thrombocytopenia in the ≥ 15-day group; this subgroup also had the lowest rates of myelotoxic co-therapy, haematology–oncology comorbidity, and PICU admission, warranting cautious interpretation. Conclusions: IV linezolid was frequently associated with early haematological toxicity, amplified by concomitant myelotoxic therapy. Sensitivity and exposure–proxy analyses support the robustness of the signal but highlight residual confounding; prospective studies with exposure monitoring are needed to establish causality.

What is Known:

• In children, haematological adverse events are the most frequent toxicities of linezolid; thrombocytopenia is typically reported after week 1.

• Paediatric evidence is limited and often confounded by concomitant myelotoxic therapies

What is New:

• In paediatric inpatients on IV linezolid, anaemia and thrombocytopenia often occur in week 1, with anaemia prominent when myelotoxic co-therapy or prior glycopeptides are present.

• In a restricted cohort excluding myelotoxic co-therapy/chemotherapy, event rates declined, yet early onset persisted, supporting robustness beyond confounding.