Comparative Effectiveness and Hematological Safety of Linezolid and Tedizolid in Bone and Joint Infections: A Retrospective Cohort Study
Abstract
Introduction Tedizolid is a promising alternative to linezolid for bone and joint infections (BJIs), but real-world comparative data remain scarce. We aimed to assess the effectiveness and hematological safety of tedizolid versus linezolid in this setting. Methods We conducted a retrospective, single-center observational study at Nimes University Hospital, a French BJIs reference center, including adults treated with linezolid or tedizolid for BJI between December 2018 and September 2023. The primary endpoint was a composite of clinical failure at end of treatment, relapse within 60 days, all-cause 1-year mortality, or antibiotic discontinuation due to adverse events. Secondary endpoints included each component separately and hematological trajectories. Inverse probability of treatment weighting was applied to adjust for confounders. Results A total of 202 patients were analyzed (147 linezolid; 55 tedizolid, including 38 switched from linezolid). Staphylococcus spp. accounted for 71% of cases, and 50.5% of infections were polymicrobial. The composite endpoint occurred in 38% of patients on linezolid and 22% on tedizolid (p = 0.04). In propensity-weighted analysis, tedizolid was non-inferior to linezolid (risk difference – 5.6%, 95% CI – 24.2–13.0%). Hematological tolerance favored tedizolid: adjusted hemoglobin and platelet count variations were significantly higher at day 28 (Δ hemoglobin + 1.09 g/dL, 0.54–1.65; p < 0.001; Δ platelets + 134.1 G/L, 92.0–176.3; p < 0.001). Conclusions Tedizolid was non-inferior to linezolid for the treatment of BJIs and was associated with improved hematological safety. These findings support the use of tedizolid as a valuable alternative in complex BJIs, particularly in patients at risk of cytopenia.
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BibTeX
@article{ain2026comparative,
title = {{Comparative Effectiveness and Hematological Safety of Linezolid and Tedizolid in Bone and Joint Infections: A Retrospective Cohort Study}},
author = {Charlène Aïn and Paul Laffont-Lozes and Albert Sotto and Julien Mazet and Aurélie Martin and Adeline Dubois and Nicolas Cellier and Paul Loubet and Romaric Larcher},
journal = {Infectious Diseases and Therapy},
year = {2026},
month = oct,
doi = {10.1007/s40121-026-01457-7},
url = {https://hal.science/hal-05841721v1},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Comparative Effectiveness and Hematological Safety of Linezolid and Tedizolid in Bone and Joint Infections: A Retrospective Cohort Study
AU - Charlène Aïn
AU - Paul Laffont-Lozes
AU - Albert Sotto
AU - Julien Mazet
AU - Aurélie Martin
AU - Adeline Dubois
AU - Nicolas Cellier
AU - Paul Loubet
AU - Romaric Larcher
PY - 2026
DA - 2026/10/27
JO - Infectious Diseases and Therapy
DO - 10.1007/s40121-026-01457-7
UR - https://hal.science/hal-05841721v1
AB - Introduction Tedizolid is a promising alternative to linezolid for bone and joint infections (BJIs), but real-world comparative data remain scarce. We aimed to assess the effectiveness and hematological safety of tedizolid versus linezolid in this setting. Methods We conducted a retrospective, single-center observational study at Nimes University Hospital, a French BJIs reference center, including adults treated with linezolid or tedizolid for BJI between December 2018 and September 2023. The primary endpoint was a composite of clinical failure at end of treatment, relapse within 60 days, all-cause 1-year mortality, or antibiotic discontinuation due to adverse events. Secondary endpoints included each component separately and hematological trajectories. Inverse probability of treatment weighting was applied to adjust for confounders. Results A total of 202 patients were analyzed (147 linezolid; 55 tedizolid, including 38 switched from linezolid). Staphylococcus spp. accounted for 71% of cases, and 50.5% of infections were polymicrobial. The composite endpoint occurred in 38% of patients on linezolid and 22% on tedizolid (p = 0.04). In propensity-weighted analysis, tedizolid was non-inferior to linezolid (risk difference – 5.6%, 95% CI – 24.2–13.0%). Hematological tolerance favored tedizolid: adjusted hemoglobin and platelet count variations were significantly higher at day 28 (Δ hemoglobin + 1.09 g/dL, 0.54–1.65; p < 0.001; Δ platelets + 134.1 G/L, 92.0–176.3; p < 0.001). Conclusions Tedizolid was non-inferior to linezolid for the treatment of BJIs and was associated with improved hematological safety. These findings support the use of tedizolid as a valuable alternative in complex BJIs, particularly in patients at risk of cytopenia.
SN - 2193-8229
SN - 2193-6382
ER -