Linezolid or Vancomycin Surgical Site Infection Prophylaxis
Status:
Not yet recruiting
Trial end date:
2026-04-03
Target enrollment:
Participant gender:
Summary
Anesthesia and surgical guidelines recommend the administration of a surgical antibiotic
prophylaxis for patients undergoing "clean" surgery. The prescribed antibiotic should target
the bacteria most commonly found in surgical site infections (SSIs) and the duration of
administration should not exceed 24 hours to minimize the ecological risk of bacterial
resistance emergence. Guidelines provide a framework for the administration of surgical
antibiotic prophylaxis but their effectiveness is regularly re-evaluated by measuring the
rates of SSIs and the microorganisms responsible for infectious complications after surgery.
The majority of interventions required the use of first or second generation cephalosporins
as surgical antibiotic prophylaxis. For patients with allergy to beta-lactams, clindamycin
and vancomycin are proposed as alternatives. In the patients with methicillin-resistant S.
aureus (MRSA) colonization or if those at risk of developing MRSA-associated SSI (hospital
ecology, previous antibiotic treatment), only vancomycin is recommended. Vancomycin
pharmacokinetics and pharmacodynamics is complex and its tissue absorption varies according
to the level of tissue inflammation. This is a difficult molecule to handle, exclusively
administered via intravenous route.
Linezolid is a synthetic antibiotic from the oxazolidinone class. By binding to the rRNA on
the 30S and 50S ribosomal subunits, it inhibits the bacterial synthesis. It is therefore a
bacteriostatic antibiotic approved for the treatment of both methicillin susceptible S.
aureus (MSSA) and MRSA infections. It also covers a broad spectrum of Gram positive bacteria.
Its pharmacokinetics allows rapid intravenous infusion, with rapid penetration into bone and
soft tissue of the surgical site during hip surgery. A large Cochrane meta-analysis reported
that linezolid was superior to vancomycin in skin infections, including MRSA infections,
albeit with low quality evidence.
We therefore hypothesized that linezolid can be used instead of vancomycin for beta-lactam
allergic patients and patients at risk of MRSA-associated SSI in general surgery.