Linezolid in bolus vs linezolid in continous infusion. The host response in patients with severe sepsis.

INTRODUCTION AND AIMS: Severe sepsis by gram positive pathogens is commonly associated with high morbidity and mortalità in every ICU. During the sepsis the coagulation cascade, the complement system and the activation system are activated, in different moments, and this contributes to the development of multiple organ failure. This activation involves all system specially in late sepsis and contributes to the development of multiple organ failure associated with high mortality rate. Linezolid ia a one of a new class of antimicrobials (oxazolidinones) for the treatment of gram positive infection such as nosocomial pneumonia (including MRSA), community acquired pneumonia, complicate and uncomplicated skin infection and vancomycin resistant Enterococcus Faecium infection. In the study we propose to compare the clinical efficacy of Linezolid in bolus vs Linezolid in continuous infusion in patients with severe sepsis and septic shock (outcome) and to analyse whether significant differences are registered in the coagulation, inflammatory and complement response between the two group of patients. METHODS: A prospective, randomized comparative trial involved not neutropenic patients admitted in ICU from January until March 2004. The 15 patients involved were those with severe sepsis or septic shock with a positive colture for gram positive and/or nosocomial pneumonia and/or complicated infection. 8 patients received iv Linezolid 600 mg q 12 h for 14 days (Group A), 7 patients iv Linezolid 600 mg as a loading dose and 1200 mg/24h as a mainteinance for 14 days. We monitored AT III, PC, via functional (activity), immunological (antigen) and ELISA. The C1-inhibitor was measured by a chromogenic functional assay. DISCUSSION AND CONCLUSION: There is not difference significant, about mortality, between the patients of Group A and Group B. The markers levels show the same trend in each group. It’s to notice the different response registered in Survivors and No Survivors group. This preliminary data confirm the important role of coagulation and complement inhibitor in the modulation of host response in septic patient