Real-world evaluation of linezolid-associated serotonin toxicity with and without concurrent serotonergic agents

Link to article at PubMed

Int J Antimicrob Agents. 2023 May 7:106843. doi: 10.1016/j.ijantimicag.2023.106843. Online ahead of print.


BACKGROUND: The risk of linezolid-associated serotonin toxicity remains unclear. We sought to evaluate the incidence of serotonin toxicity among hospitalized patients who received linezolid with or without concurrent serotonergic agents (SA). Secondary outcomes were to assess the dose, agent selection, and number of SA.

METHODS: A single-center, retrospective cohort study was performed of hospitalized patients ≥18 years of age who received ≥1 dose of linezolid with or without SA between 1/1/14-6/30/2021. Patients were excluded if <18 years of age, had linezolid ordered but not administered, were pregnant, or incarcerated. Up to five concurrent SA were assessed, and dose category was divided into low, moderate, and high based on if the dose was <33%, 33-66%, and >66% of the maximum daily dose, respectively. Serotonin toxicity was identified by searching patients' electronic medical records. If identified, the Sternbach Criteria and Hunter criteria were applied.

RESULTS: Of 2022 patients screened, 1743 were included. Mean age, weight, and linezolid duration were 58.5 years, 90.7 kg, and 3.8 days, respectively. Approximately 67% (1168/1743) received linezolid with ≥1 SA, and several patients received multiple SA. Most patients (53.8%; 616/1144) received moderate and/or high dose SA. Only 2 patients (0.11%) were identified as possible serotonin toxicity based on the electronic medical record search. However, the incidence of serotonin toxicity was 0.06% (1/1743) and 0% (0/1743) based on Sternbach Criteria and Hunter Criteria, respectively.

CONCLUSIONS: Serotonin toxicity among hospitalized patients who received linezolid with or without SA was exceedingly rare, even among those who received multiple and higher dose SA.

PMID:37160238 | DOI:10.1016/j.ijantimicag.2023.106843

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