Medline ® Abstracts for References 45,46
of 'Treatment of community-acquired pneumonia in adults who require hospitalization'
How important is methicillin-resistant Staphylococcus aureus as a cause of community-acquired pneumonia and what is best antimicrobial therapy?
Infect Dis Clin North Am. 2013 Mar;27(1):177-88. Epub 2012 Dec 14.
The emergence of methicillin-resistant strains of Staphylococcus aureus has raised issues regarding the importance of methicillin-resistant S aureus (MRSA) in community-acquired pneumonia (CAP) and its optimal treatment. Community-acquired MRSA (CA-MRSA) is an important cause of CAP because of the high mortality if not suspected early, and its occurrence in young patients with long life expectancy. Certain clinical features can increase the probability of CA-MRSA as a cause of CAP. The consistent trend toward better outcomes for documented MRSA pneumonia suggests that linezolid be considered the drug of choice for documented MRSA CAP, especially for CA-MRSA.
Pulmonary and Critical Care Division, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. firstname.lastname@example.org
Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study.
Wunderink RG, Niederman MS, Kollef MH, Shorr AF, Kunkel MJ, Baruch A, McGee WT, Reisman A, Chastre J
Clin Infect Dis. 2012;54(5):621.
BACKGROUND: Post hoc analyses of clinical trial data suggested that linezolid may be more effective than vancomycin for treatment of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia. This study prospectively assessed efficacy and safety of linezolid, compared with a dose-optimized vancomycin regimen, for treatment of MRSA nosocomial pneumonia.
METHODS: This was a prospective, double-blind, controlled, multicenter trial involving hospitalized adult patients with hospital-acquired or healthcare-associated MRSA pneumonia. Patients were randomized to receive intravenous linezolid (600 mg every 12 hours) or vancomycin (15 mg/kg every 12 hours) for 7-14 days. Vancomycin dose was adjusted on the basis of trough levels. The primary end point was clinical outcome at end of study (EOS) in evaluable per-protocol (PP) patients. Prespecified secondary end points included response in the modified intent-to-treat (mITT) population at end of treatment (EOT) and EOS and microbiologic response in the PP and mITT populations at EOT and EOS. Survival and safety were also evaluated.
RESULTS: Of 1184 patients treated, 448 (linezolid, n = 224; vancomycin, n = 224) were included in the mITT and 348 (linezolid, n = 172; vancomycin, n = 176) in the PP population. In the PP population, 95 (57.6%) of 165 linezolid-treated patients and 81 (46.6%) of 174 vancomycin-treated patients achieved clinical success at EOS (95% confidence interval for difference, 0.5%-21.6%; P = .042). All-cause 60-day mortality was similar (linezolid, 15.7%; vancomycin, 17.0%), as was incidence of adverse events. Nephrotoxicity occurred more frequently with vancomycin (18.2%; linezolid, 8.4%).
CONCLUSIONS: For the treatment of MRSA nosocomial pneumonia, clinical response at EOS in the PP population was significantly higher with linezolid than with vancomycin, although 60-day mortality was similar.
Department of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. email@example.com