Background Neonatal late-onset sepsis (LOS) is mainly caused by coagulase-negative staphylococci (CoNS). Most LOS-associated CoNS are resistant to methicillin, leading to a frequent use of vancomycin. We recently reported the dissemination of a Staphylococcus capitis clone with reduced vancomycin susceptibility in NICUs worldwide, raising the need to evaluate alternative anti-staphylococcal therapies such as linezolid.

Aims To compare outcomes of linezolid- and vancomycin-treated S. capitis LOS patients.

Methods Neonates who had S. capitis LOS from 2011 till 2013 in 3 French NICUs were included. Data regarding birth, antibiotic regimen and outcome were collected. Comparisons were made between patients treated with vancomycin only (n = 66) and patients treated with linezolid, preceded or not by vancomycin (n = 29), using either Student t-test or Fisher’s exact test.

Results No significant difference regarding pre-treatment status were found between the groups. Linezolid-treated patients had significantly longer hospital stays and bacteremia and longer inflammatory syndrome. Frequencies of death, major morbidities (bronchopulmonary dysplasia, persistent ductus arteriosus and necrotising enterocolitis) and severe adverse events (haematological toxicity, neuropathy and renal failure) did not differ significantly between groups.

Discussion These findings suggest that linezolid safety and efficacy regarding death and morbidity in S. capitis-infected neonates are comparable to that of vancomycin. Longer bacteremia durations observed in linezolid-treated patients might be due to the fact that linezolid prescription was driven by a poorer estimated prognosis (vancomycin-resistant strain, prolonged bacteremia). Overall, we propose that linezolid could emerge as a credible alternative to vancomycin in the current context of vancomycin-resistant strain dissemination in the NICU.