Sequential Therapy with Linezolid and Contezolid to Treat Hematogenous Lung Abscess Diagnosed via Next Generation Sequencing in a Patient with Congenital Brain Hypoplasia: A Case Report and Literature Review

Staphylococcus aureus is a common pathogen implicated in hematogenous lung abscesses. The increased tolerance of S. aureus to antibiotics makes infections difficult to treat, leading to poor prognosis. Therefore, it is important to identify S. aureus infection as early as possible and evaluate its sensitivity and resistance to antibiotics in order to formulate an appropriate treatment plan. Oxazolidinone antibiotics have potent antibacterial activity against multidrug-resistant (MDR) S. aureus. However, the adverse effects of linezolid, especially thrombocytopenia, limit its application. Contezolid can ameliorate the hematologic toxicity caused by linezolid. Here, we report a case of a patient with congenital brain hypoplasia who was hospitalized due to fever and multiple abscesses in both lungs. In the case of negative blood culture, targeted next-generation sequencing (tNGS) and metagenomics next-generation sequencing (mNGS) were used to detect the pathogenic microorganisms, via which the causative pathogen of the hematogenous lung abscesses was identified as MDR S. aureus.Initially, the patient was treated with linezolid but developed clear thrombocytopenia.After switching to sequential therapy with contezolid, the patient's platelet counts returned to normal, and his condition improved significantly.