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HAP patients who treated with linezolid were collected and divided into TBI and non-TBI groups. Differences in the linezolid C\n                    <jats:sub>min<\/jats:sub>\n                    , Gram-positive bacterial eradication, clinical treatment success, and adverse reactions were analyzed between the two groups. A total of 177 patients were enrolled in the study, including 57 with TBI and 120 without TBI. After 1:1 propensity score matching (PSM), 46 patients with well-balanced baseline levels were enrolled. Linezolid C\n                    <jats:sub>min<\/jats:sub>\n                    and Gram-positive bacterial eradication rate were lower in TBI group than in non-TBI group [2.06 (0.89, 6.89) mg\/L, 6.70 (3.09, 13.48) mg\/L,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001; 69.0% vs. 90.9%,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.029]. Linezolid-induced thrombocytopenia (LIT) and severe LIT occurred in fewer patients in TBI group than in non-TBI group (4.3% vs. 28.3%,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.005; 2.2% vs. 17.4%,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.035). The linezolid C\n                    <jats:sub>min<\/jats:sub>\n                    for the predicted eradication of Gram-positive bacterial was 1.62\u00a0mg\/L. Further studies have found that the use of mannitol, glycerin fructose and high fluid intake and output may be responsible for the low C\n                    <jats:sub>min<\/jats:sub>\n                    of linezolid in TBI group. Patients in TBI group had lower linezolid C\n                    <jats:sub>min<\/jats:sub>\n                    and Gram-positive bacterial eradication rates compared with those in non-TBI group. A lower C\n                    <jats:sub>min<\/jats:sub>\n                    level may predict a decrease in Gram-positive bacterial eradication rates, and patients with concomitant TBI may need to explore higher linezolid doses.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-28571-9","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T14:51:48Z","timestamp":1767019908000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of traumatic brain injury on the trough concentration of linezolid in patients with hospital-acquired pneumonia"],"prefix":"10.1038","volume":"15","author":[{"given":"Ying","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lian","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mian","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwei","family":"Zhuang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhui","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanxia","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zicheng","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangjuan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,29]]},"reference":[{"key":"28571_CR1","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1007\/s12028-019-00773-w","volume":"32","author":"Y Li","year":"2020","unstructured":"Li, Y. et al. 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