Cost avoidance using linezolid for methicillin-resistant Staphylococcus aureus infections in a specialist diabetes foot clinic

An audit was performed to determine whether linezolid (Zyvox, Pharmacia Limited, Sandwich, UK) was being used in accordance with local guidelines and if this had an effect on admissions for diabetes foot ulceration. Seven hundred and four patient records from 2005 to 2010 in the Diabetes Foot Clinic, Royal Infirmary of Edinburgh were audited for methicillin-resistant Staphylococcus aureus (MRSA) infections, admissions and antibiotic use. Seventeen percent (n119) of patients had proven MRSA infections. Of these, 28 (n33) were prescribed linezolid, 94 (n31) for up to 14 days and none for 28 days. Eight (24) had repeated courses. Ninety-one percent (n30) either avoided admission or were discharged early with resolution of infection. Four out of 33 patients had reversible blood abnormalities. The total cost for linezolid over this period was 58000. However, 420 bed days, costing 500/day, were avoided, producing a total saving of 210000 on inpatient costs. Linezolid guidelines reduced lengths of stay, inpatient costs and overuse of this expensive but effective treatment.