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Antibiotics
Volume 14
Issue 12
10.3390/antibiotics14121188
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Linezolid Serum Concentration Variability Among Critically Ill Patients Based on Renal Function and Continuous Renal Replacement Therapy Administration

by
Stefano Agliardi
1,2,*,
Beatrice Brunoni
3,
Gianluca Gazzaniga
1,4,
Leonardo Baggio
3,
Riccardo Giossi
2,
Greta Guarnieri
1,
Stefania Paccagnini
2,
Matteo Laratta
5,
Thomas Langer
3,5,
Sara Santambrogio
5,
Gianpaola Monti
5,
Romano Danesi
2,6,
Francesco Scaglione
6,
Arianna Pani
6 and
Roberto Fumagalli
3,5
1
Department of Medical Biotechnologies and Translational Medicine, Post-Graduate School of Pharmacology and Clinical Toxicology, University of Milan, 20122 Milan, Italy
2
Chemical-Clinical Analyses, Poison Control Center and Clinical Pharmacology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
3
Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
4
Department of General Surgery, Surgical Specialty and Anesthesiology Paride Stefanini, Sapienza University of Rome, 00161 Rome, Italy
5
Department of Anesthesia and Intensive Care Medicine ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
6
Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
*
Author to whom correspondence should be addressed.
Antibiotics 2025, 14(12), 1188; https://doi.org/10.3390/antibiotics14121188
Submission received: 16 September 2025 / Revised: 15 November 2025 / Accepted: 17 November 2025 / Published: 21 November 2025
Review Reports Versions Notes

Abstract

Background: Linezolid standard dosing is typically applied in ICU without adjustments, even in renal impairment. This study examines serum concentration variability by renal function or CRRT administration in patients receiving 1200 mg/day of linezolid. Methods: This retrospective, single-center, non-randomized observational study was conducted at Niguarda Hospital (Milan, Italy) on data from the two-year period 2023–2024. ICU patients receiving linezolid, with a renal function determination and trough TDM performed at steady-state were included and stratified by renal function or CRRT status. Results: 54 patients were included, with 18 (33%) undergoing CRRT (CVVH). CRRT patients presented higher median linezolid concentrations (4.6 mg/L) than non-CRRT patients (3.2 mg/L), and a lower risk of underdosing (17% vs. 39%). CRRT patients showed significantly lower concentrations (4.6 mg/L vs. 10 mg/L, p = 0.007) than non-CRRT patients with renal function ≤ 30 mL/min, with fewer out-of-range levels (39% vs. 91%, p = 0.008) and overdosing (22% vs. 73%, p = 0.018). A significant inverse correlation was found between renal function and linezolid levels (Spearman’s rho = −0.61, p < 0.001), with CRRT patients exhibiting concentrations comparable to those of individuals with moderately impaired renal function. Continuous infusion resulted in significantly higher median concentrations (7.2 mg/L) than extended infusion (2.7 mg/L), with an increased risk of overdosing (47% vs. 17%; p = 0.018). Conclusions: After standard-dosing administration, linezolid levels vary widely in critically ill patients. Renal function significantly affects pharmacokinetics: severe impairment increases overdose risk, while ARC may cause underdosing. Standard-dosing appears adequate in CRRT patients, with levels similar to moderate-impairment. Continuous infusion aids target attainment in normal or ARC patients but raises overdose risk in severe impairment. TDM-based personalized dosing seems crucial to optimize therapy and reduce toxicity or failure.
Keywords: linezolid; antimicrobials; therapeutic drug monitoring; intensive care; pharmacokinetics linezolid; antimicrobials; therapeutic drug monitoring; intensive care; pharmacokinetics

Share and Cite

MDPI and ACS Style

Agliardi, S.; Brunoni, B.; Gazzaniga, G.; Baggio, L.; Giossi, R.; Guarnieri, G.; Paccagnini, S.; Laratta, M.; Langer, T.; Santambrogio, S.; et al. Linezolid Serum Concentration Variability Among Critically Ill Patients Based on Renal Function and Continuous Renal Replacement Therapy Administration. Antibiotics 2025, 14, 1188. https://doi.org/10.3390/antibiotics14121188

AMA Style

Agliardi S, Brunoni B, Gazzaniga G, Baggio L, Giossi R, Guarnieri G, Paccagnini S, Laratta M, Langer T, Santambrogio S, et al. Linezolid Serum Concentration Variability Among Critically Ill Patients Based on Renal Function and Continuous Renal Replacement Therapy Administration. Antibiotics. 2025; 14(12):1188. https://doi.org/10.3390/antibiotics14121188

Chicago/Turabian Style

Agliardi, Stefano, Beatrice Brunoni, Gianluca Gazzaniga, Leonardo Baggio, Riccardo Giossi, Greta Guarnieri, Stefania Paccagnini, Matteo Laratta, Thomas Langer, Sara Santambrogio, and et al. 2025. "Linezolid Serum Concentration Variability Among Critically Ill Patients Based on Renal Function and Continuous Renal Replacement Therapy Administration" Antibiotics 14, no. 12: 1188. https://doi.org/10.3390/antibiotics14121188

APA Style

Agliardi, S., Brunoni, B., Gazzaniga, G., Baggio, L., Giossi, R., Guarnieri, G., Paccagnini, S., Laratta, M., Langer, T., Santambrogio, S., Monti, G., Danesi, R., Scaglione, F., Pani, A., & Fumagalli, R. (2025). Linezolid Serum Concentration Variability Among Critically Ill Patients Based on Renal Function and Continuous Renal Replacement Therapy Administration. Antibiotics, 14(12), 1188. https://doi.org/10.3390/antibiotics14121188

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