European perspective and update on the management of nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus after more than 10 years of experience with linezolid

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of antimicrobial-resistant hospital-acquired infections worldwide and remains a public health priority in Europe. Nosocomial pneumonia (NP) involving MRSA often affects patients in intensive care units with substantial morbidity, mortality and associated costs. A guideline-based approach to empirical treatment with an antibacterial agent active against MRSA can improve the outcome of patients with MRSA NP, including those with ventilator-associated pneumonia. New methods may allow more rapid or sensitive diagnosis of NP or microbiological confirmation in patients with MRSA NP, allowing early de-escalation of treatment once the pathogen is known. In Europe, available antibacterial agents for the treatment of MRSA NP include the glycopeptides (vancomycin and teicoplanin) and linezolid (available as an intravenous or oral treatment). Vancomycin has remained a standard of care in many European hospitals; however, there is evidence that it may be a suboptimal therapeutic option in critically ill patients with NP because of concerns about its limited intrapulmonary penetration, increased nephrotoxicity with higher doses, as well as the emergence of resistant strains that may result in increased clinical failure. Linezolid has demonstrated high penetration into the epithelial lining fluid of patients with ventilator-associated pneumonia and shown statistically superior clinical efficacy versus vancomycin in the treatment of MRSA NP in a phase IV, randomized, controlled study. This review focuses on the disease burden and clinical management of MRSA NP, and the use of linezolid after more than 10 years of clinical experience.

Review of vancomycin-induced renal toxicity: an update

“…Given the large doses required and to circumvent nephrotoxicity, alternative therapy (e.g. linezolid) is recommended if MIC is greater than 2 mg/l [Rybak et al 2009;Chastre et al 2014].…”

Discussion autour d’un cas mortel de pneumonie nécrosante à Staphylococcus aureus sécrétant la leucocidine de Panton-Valentine

“…Deux antibiotiques, la clindamycine et le linézolide, sont intéressants pour leur efficacité contre le SARM, leur effet antitoxinique et leur diffusion à la fois pulmonaire et tissulaire [9,10]. Ils améliorent le pronostic des chocs toxiniques streptococcique et staphylococcique [11,12].…”

“…Le linézo-lide a montré sa supériorité sur la résolution clinique de l'infection par rapport à la vancomycine dans les pneumonies nosocomiales à SARM, le premier ayant une meilleure diffusion pulmonaire [10]. Des références formalisées d'experts rédigées en 2014 sous l'égide de la Société de Réanimation de Langue Française et de la Société Française d'Anesthésie Réanimation, visant à réduire l'utilisation des antibiotiques en réanimation, préconisent l'utilisation du linézolide dans les pneumonies acquises sous ventilation mécanique à SARM (accord fort).…”

Myeloid-related protein-14 deficiency promotes inflammation in staphylococcal pneumonia

“…In the past few decades, methicillin-resistant Staphylococcus aureus (MRSA) has evolved as the most important cause of nosocomial infections, including hospital-acquired and ventilator-associated pneumonia [1,2]. In recent years, virulent strains of community-associated MRSA have also emerged, causing infections in individuals without recognised risk factors [1,3].…”