Efficacy and safety of contezolid in the treatment of Gram-positive bacterial infections in patients with hematological malignancies: a retrospective study.

Purpose: Contezolid, an oxazolidinone antibiotic, is recognized for its comparable antimicrobial activity to linezolid, with a distinct advantage of reduced hematological toxicity. This retrospective analysis aims to evaluate the safety and efficacy profile of contezolid in the treatment of Gram-positive bacterial infections (GPI) in hematological patients.

Methods: A retrospective analysis was conducted on adult hematological patients with confirmed or suspected GPI who received contezolid for at least three days following chemotherapy or hematopoietic stem cell transplantation (HSCT) at Henan Cancer Hospital between April 2022 and June 2024. Comprehensive data collection included demographic variables, treatment protocols, infection profiles, microbiological data, and clinical outcomes.

Results: The study included 132 patients (47.5 ± 18.0 years), 61.4% male. Treatment strategies for hematological malignancies included combination chemotherapy with targeted therapy (41.7%), chemotherapy alone (37.9%), and HSCT (20.5%). 60.6% had febrile neutropenia. More than half of the infections occurred within one month after treatment, predominantly affecting the lungs and skin/soft tissue. Two patients had concurrent bloodstream infections (BSI) prior to receiving contezolid treatment. The median contezolid treatment was 12 days, 72.7% had it as initial treatment. The rationale for contezolid utilization includes complicated skin and soft-tissue infections (cSSTI), prior treatment failure, adverse reactions, and contraindications. Clinical effective rate was 70.6% (95% CI: 62.7% - 78.5%), with 64.4% (95% CI: 52.2% - 76.6%) in pneumonia, 74.6% (95% CI: 63.0% - 86.1%) in skin or soft tissue infections, and 69.3% (95% CI: 58.9% - 79.8%) in febrile neutropenia. Seventeen patients (12.9%) had adverse events. Twelve had new-onset/aggravated nausea or epigastric discomfort, and seven had vomiting; these may relate to contezolid. No contezolid-related hematological adverse events, optic or peripheral neuropathy were observed.

Conclusions: Contezolid seems promising for these patients, but large-scale prospective studies are needed for confirmation.