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<p>Post-neurosurgical central nervous system (CNS) infections are associated with prolonged hospital stays and poor neurological outcomes. Given the predominance of Gram-positive bacteria as causative pathogens, vancomycin is the first-line treatment. However, its use is limited by nephrotoxicity, the global emergence of resistant strains, and unfavorable pharmacokinetics with poor cerebrospinal fluid penetration. Therefore, linezolid may be a promising alternative. This systematic review assesses the current evidence regarding its efficacy and safety in the treatment of post-neurosurgical CNS infections. This review was registered in PROSPERO (CRD42024496278) and adhered to PRISMA guidelines. A literature search was conducted across five databases (PubMed, Web of Science, CINAHL Complete, Dimensions, and the Cochrane Library). A risk of bias and quality assessment procedure (MINORS scale) was conducted for non-case-reports studies. We extracted epidemiological, microbiological, and pharmacological data, along with clinical outcomes and safety issues. Out of 611 records screened, 36 studies were included—27 of which were case reports. According to MINORS scores, most non-case-report studies exhibited poor (7/9) or moderate (2/9) methodological quality. Linezolid was primarily employed as a second-line therapy due to treatment failure (46.3%) or culture of glycopeptide-resistant strains (20.6%). Methicillin-resistant Staphylococci (67%) and Vancomycin-Resistant Enterococci (8.2%) were most commonly identified. The oral route was used in 41.4% of cases. Low mortality (10.6%) and high but variable microbiological cure rates (65%) were reported. Adverse events occurred in 10 to 27.3% of patients, with hematological toxicity being the most common. Although linezolid shows promise in treating post-neurosurgical CNS infections, current evidence relies heavily on case reports and methodologically limited retrospective studies. Further rigorous research, including prospective trials, is needed to establish its role in these infections.&#xa0;</p>

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Linezolid use in post-neurosurgical central nervous system infections: A systematic review

  • 期刊论文

  • 发表日期：

    2025年10月16日

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  • Charles Baulier,
  • Noémie Le Dentu,
  • Mathieu Lozouet,
  • Yves Kam,
  • Gaétan Kerdelhué,
  • Marion Giry,
  • Kévin Alexandre,
  • Thomas Clavier

摘要

Post-neurosurgical central nervous system (CNS) infections are associated with prolonged hospital stays and poor neurological outcomes. Given the predominance of Gram-positive bacteria as causative pathogens, vancomycin is the first-line treatment. However, its use is limited by nephrotoxicity, the global emergence of resistant strains, and unfavorable pharmacokinetics with poor cerebrospinal fluid penetration. Therefore, linezolid may be a promising alternative. This systematic review assesses the current evidence regarding its efficacy and safety in the treatment of post-neurosurgical CNS infections. This review was registered in PROSPERO (CRD42024496278) and adhered to PRISMA guidelines. A literature search was conducted across five databases (PubMed, Web of Science, CINAHL Complete, Dimensions, and the Cochrane Library). A risk of bias and quality assessment procedure (MINORS scale) was conducted for non-case-reports studies. We extracted epidemiological, microbiological, and pharmacological data, along with clinical outcomes and safety issues. Out of 611 records screened, 36 studies were included—27 of which were case reports. According to MINORS scores, most non-case-report studies exhibited poor (7/9) or moderate (2/9) methodological quality. Linezolid was primarily employed as a second-line therapy due to treatment failure (46.3%) or culture of glycopeptide-resistant strains (20.6%). Methicillin-resistant Staphylococci (67%) and Vancomycin-Resistant Enterococci (8.2%) were most commonly identified. The oral route was used in 41.4% of cases. Low mortality (10.6%) and high but variable microbiological cure rates (65%) were reported. Adverse events occurred in 10 to 27.3% of patients, with hematological toxicity being the most common. Although linezolid shows promise in treating post-neurosurgical CNS infections, current evidence relies heavily on case reports and methodologically limited retrospective studies. Further rigorous research, including prospective trials, is needed to establish its role in these infections.