Early experience with nurse-led Linezolid monitoring

Slide set is adapted from a poster presented at the Federation of Infection Societies in 2014. "Nurse-led monitoring via an OPAT service - Objectives." The objectives include monitoring and evaluating a nurse-led weekly Linezolid service at Hull and East Yorkshire Hospitals.

These slides describe our early experiences of specialist nurse-led Linezolid monitoring within our OPAT service.

Method

A service evaluation was performed. Patients were identified by review of OPAT service records. Clinical information was extracted from the hospital’s electronic patient results system. Data was recorded and analysed using Excel. Descriptive statistics are presented with the X2 test or Yate’s X2 test used to compare differences between groups.

Results

Since November 2010, 70 patients have been referred to the service (74% male, 26% female; age range 15 to 85 years). All patients were reviewed by a trained OPAT specialist nurse (also an independent prescriber) and had bloods taken weekly with medical review individualised to each patient’s underlying infection and ongoing needs.

3D pie chart showing "Diagnoses of patients prescribed outpatient linezolid, n=70." Prosthetic joint and skin/soft tissue have the highest percentage, followed by osteomyelitis, septic arthritis, blood/endocarditis, spinal, brain, and intra-abdominal. Figure 1.

Treatment duration varied from 1 to 13 weeks; median = 4 weeks. Diagnoses of patients prescribed outpatient Linezolid are shown in Fig.1.

3D pie chart showing "Percentage of patients suffering adverse effects, n=70." Nausea and amnesia were suffered by the highest percentage, followed by mouth, low platelets, malaise, folliculitis. Figure 2.

37% of patients suffered at least one adverse effect. The percentage of patients suffering specific adverse effects is shown in Fig.2.

Bar graph showing "Number of patients stopping linezolid by reason and week." The graph shows results for 6 weeks, and shows the number of patients who continued beyond the week, the number who finished the course, and the number who stopped due to adverse effects. The number of those who continued beyond the week stedily decreases as the number of weeks goes on. Figure 3.

Most patients (76%) completed the intended course of Linezolid, but 21% changed to an alternative regimen and 3% stopped early. The most common reasons for changing/stopping Linezolid were severe nausea (35%) and low haemoglobin (22%). Fig. 3 shows why patients stopped Linezolid by week.

Two patients required hospitalisation for blood transfusion. In both instances, haemoglobin levels continued to fall in the 2 weeks following discontinuation of Linezolid.

Bar chart showing "Proportion of patients on different linezolid regimens completing course". This compares linezolid/ciprofloxacin, linezolid/doxycycline, and monotherapy. Figure 4.

44% of patients received combination therapy; most commonly with Ciprofloxacin (24%) and Doxycycline (14%). A higher proportion of patients completed the planned course when receiving Linezolid monotherapy compared to those also taking Ciprofloxacin or Doxycycline (82% versus 63%; X2 test = 3.04, p = 0.08); see Fig. 4.

Age was the strongest predictor of completion of therapy with 93% (N = 29) of those under 60 years compared to 63% (N = 41) of older patients completing the planned course of Linezolid; X2 test = 8.14, p = 0.0004.

A higher proportion of male patients (81% versus 61% in females; Yate’s X2 test = 1.84, p = 0.17) completed their planned course of Linezolid; this did not appear to be due to differences in mean age or use of concomitant antibiotics.

Conclusions:

  • Nurse-led Linezolid monitoring via an OPAT service is feasible allowing the early detection of, and response to, adverse effects.

  • Two patients (3%) suffered progressive symptomatic anaemia after stopping therapy requiring readmission to hospital and blood transfusion, emphasising the importance of post-completion monitoring in those who develop anaemia.

  • Most patients completed the planned course of Linezolid. Age was the strongest predictor of non-completion; this did not appear to be due to differences in measured potential confounders between age groups.

  • When using Linezolid, concomitant antibiotic therapy is probably best avoided whenever possible.


Do our findings align with your experiences? Comment your experiences of monitoring Linezolid (if any) and discuss with your fellow learners.

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