Hyperlactacidemia Potentially Due to Linezolid Overexposure in a Liver Transplant Recipient

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Abstract
Sir—A 59-year-old white liver transplant recipient developed bilateral pneumonia on day 4 after the operation. After performing bronchoscopy with bronchoalveolar lavage, empirical therapy with piperacillin-tazobactam (4.5 g every 6 h) and levofloxacin (500 mg every 12 h) was commenced. During the subsequent 24 h, the patient's clinical condition worsened until he developed severe sepsis. Drotrecogin-α was administered, but because of the persistence of the patient's critical condition, and because no bacteria were isolated, antibiotic therapy was shifted 48 h later to meropenem (500 mg every 6 h) plus linezolid (600 mg every 12 h).