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The following is a summary of “Vancomycin versus linezolid for treatment of staphylococcal-associated central nervous system infections,” published in the March 2025 issue of BMC Infectious Diseases by Lahouati et al. 

Linezolid and vancomycin were recommended for treating staphylococcal-associated central nervous system (CNS) infections, but no data compared their outcomes.  

Researchers conducted a retrospective study to compare the incidence of treatment failure and adverse events (AEs) associated with vancomycin and linezolid in staphylococcal-associated CNS infections.  

They included individuals with confirmed staphylococcal-associated CNS infections treated with vancomycin or linezolid between 01/01/2015 and 31/12/2023. The primary outcome was antimicrobial treatment failure, defined by a composite criterion: persistence of infection (positive culture after >72 hours of active antimicrobial treatment), relapse (new infection with the same bacteria), or infection-related death. The secondary outcome was the incidence of AEs related to linezolid or vancomycin. Survival analysis techniques and propensity score methods were used for outcome analysis.  

The results showed that 91 individuals were included, with 51 receiving vancomycin and 40 receiving linezolid. Meningitis accounted for most infections (n = 71; 78%). The median treatment duration for both antibiotics was 7 days (interquartile range [IQR] 4; 13). Treatment failure occurred in 18.6% (n = 17), with infection persistence in 9.8% (n = 9), relapse in 6.6% (n = 6), and infection-related mortality in 4.4% (n = 4). In the Cox proportional hazards regression model, vancomycin was not significantly associated with treatment failure (aHR 2.90; 95% CI 0.93–9.30; P = 0.066). However, propensity score analysis showed an association between vancomycin and treatment failure (HR 3.28; 95% CI [1.02–10.54]; P = 0.045). Vancomycin use was also linked to AEs (HR 8.42; 95% CI [2.44–29.10]; P = 0.019).  

Investigators concluded that patients treated with vancomycin for staphylococcal-associated CNS infections had appeared to face a greater risk of treatment failure and AEs compared to those treated with linezolid.   

Source: bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-025-10834-5