Linezolid has been increasingly used in tertiary NICUs. The objectives of this study were to explore the indications of these linezolid prescriptions, to analyze a possible misuse and to provide solutions to avoid such misuse. A monocentric retrospective cohort study included all neonates hospitalized in one tertiary NICU between January 1st, 2010 and December 31st, 2019 and who received at least one administration of linezolid. These data were confronted to epidemiological and antibiotic use data from the same NICU. Two independent pediatricians secondarily classified linezolid uses as adequate or not. During the study period, 66 infections in 57 patients led to linezolid use. Most patients were pre-term and 21 patients (37%) died. Infections were mainly related to methicillin-resistant coagulase negative staphylococci and were frequently either pneumoniae (35%) or isolated bacteremia (48%), including 25 persistent bacteremia (64% of the 39 bacteremia). Need for a better tissue distribution or first-line treatment failure were the main reasons to initiate linezolid. Linezolid was administered for a median duration of 7 [3;10] days. No side effects were reported. Twenty-two (33%) of the 66 linezolid prescriptions were retrospectively classified as inadequate. A rapid increase in linezolid prescriptions has been observed in our tertiary NICU, from 2014 to 2019, with 33% inadequate uses. This worrisome trend should lead to search for therapeutic alternatives and to work on antibiotic stewardship to prevent the emergence of new antimicrobial bacterial resistance.

中文翻译：

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10 年内在三级 NICU 中增加利奈唑胺的使用：未来的原因和担忧。

利奈唑胺已越来越多地用于三级 NICU。本研究的目的是探索这些利奈唑胺处方的适应症，分析可能的误用并提供避免此类误用的解决方案。一项单中心回顾性队列研究纳入了 2010 年 1 月 1 日至 2019 年 12 月 31 日期间在一家三级 NICU 住院且至少接受过一次利奈唑胺给药的所有新生儿。这些数据与来自同一新生儿重症监护病房的流行病学和抗生素使用数据相比较。两名独立的儿科医生将利奈唑胺的使用归类为足够与否。在研究期间，57 名患者的 66 次感染导致使用利奈唑胺。大多数患者早产，21 名患者 (37%) 死亡。感染主要与耐甲氧西林凝固酶阴性葡萄球菌有关，通常为肺炎（35%）或孤立菌血症（48%），包括 25 例持续性菌血症（39 例菌血症的 64%）。需要更好的组织分布或一线治疗失败是开始使用利奈唑胺的主要原因。使用利奈唑胺的中位持续时间为 7 [3;10] 天。没有报告副作用。66 份利奈唑胺处方中有 22 份（33%）被回顾性归类为不充分。从 2014 年到 2019 年，我们的三级新生儿重症监护病房观察到利奈唑胺处方迅速增加，33% 的使用不当。这种令人担忧的趋势应该导致寻找治疗替代方案并致力于抗生素管理以防止出现新的抗微生物细菌耐药性。