Linezolid Versus Vancomycin for Methicillin-Resistant Staphylococcus aureus Nosocomial Pneumonia: Controversy Continues

Masuta, Kana; Oba, Yuichiro; Iwata, Kentaro

doi:10.1093/cid/cis331

Cited by 15 publications

(12 citation statements)

References 1 publication

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“…In the ZEPHyR study, all‐cause 60‐day mortality rates were comparable in the linezolid and vancomycin treatment arms (15.7% and 17.0% (intention‐to‐treat population), respectively) . Several authors have commented on the lack of mortality difference between the treatment groups; ; however, the ZEPHyR study was not designed nor statistically powered to detect a mortality difference .…”

Section: Clinical Management Of Mrsa Np With Linezolidmentioning

confidence: 99%

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

Chastre

Blasi

Masterton

et al. 2014

Clinical Microbiology and Infection

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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.

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Section: Clinical Management Of Mrsa Np With Linezolidmentioning

confidence: 99%

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

Chastre

Blasi

Masterton

et al. 2014

Clinical Microbiology and Infection

View full text Add to dashboard Cite

show abstract

“…In a randomised study, linezolid has demonstrated a higher success rate than vancomycin in nosocomial pneumonia due to MRSA (ZEPHyR study); however, mortality was similar in both arms and some authors criticised the vancomycin dosage [89][90][91], therefore there is still a debate in the literature about the first-line agent for MRSA pneumonia [92,93].…”

Section: Comparative Studies With Linezolidmentioning

confidence: 99%

Treatment options for methicillin-resistant Staphylococcus aureus (MRSA) infection: Where are we now?

Edwards

Andini

Esposito

et al. 2014

Journal of Global Antimicrobial Resistance

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“…A recent prospective randomized controlled trial of culture‐confirmed MRSA nosocomial pneumonia showed benefits for linezolid over vancomycin for clinical success but no significant differences in mortality . Limitations of these studies, specifically their methodological and statistical approaches, have been noted in multiple commentaries …”

mentioning

confidence: 99%

“…20 Limitations of these studies, specifically their methodological and statistical approaches, have been noted in multiple commentaries. [21][22][23][24][25][26][27][28] These randomized trials provide important comparative efficacy data; however, they may not reflect the effectiveness of these agents in real-world clinical practice. MRSA pneumonia is a complex disease with significant morbidity and mortality; therefore, evaluating real-world effec-tiveness in treating this disease is essential.…”

mentioning

confidence: 99%

Comparative Effectiveness of Linezolid and Vancomycin Among a National Veterans Affairs Cohort with Methicillin‐Resistant Staphylococcus aureus Pneumonia

et al. 2014

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Study Objective As variability in vancomycin dosing, susceptibility, and tolerability has driven the need to compare newer agents with vancomycin in real‐world clinical settings, we sought to quantify the effectiveness of linezolid compared with vancomycin on clinical outcomes for the treatment of methicillin‐resistant Staphylococcus aureus (MRSA) pneumonia. Design Retrospective cohort study. Data Source Veterans Health Administration national databases. Patients Adults admitted to Veterans Affairs hospitals between January 2002 and September 2010 with diagnosis codes for MRSA and pneumonia, plus initiation and receipt of at least 3 days of continuous intravenous vancomycin therapy (4943 patients) or intravenous or oral linezolid therapy (328 patients) while in the hospital. Measurements and Main Results Propensity score–adjusted Cox proportional hazards regression models quantified the effect of linezolid compared with vancomycin on time to 30‐day mortality (primary outcome), therapy change, hospital discharge, discharge from intensive care, intubation, 30‐day readmission, and 30‐day MRSA reinfection. In addition, a composite outcome of clinical success was defined as discharge from the hospital or intensive care unit by day 14 after treatment initiation, in the absence of death, therapy change, or intubation by day 14. Subgroup analyses were performed in a validated microbiology‐confirmed MRSA subgroup and clinical subgroup meeting clinical criteria for infection. Although a number of baseline variables differed significantly between the vancomycin and linezolid treatment groups, balance was achieved within propensity score quintiles. A significantly lower rate of therapy change was observed in the linezolid group (adjusted hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.48–0.96). The clinical success rate was significantly higher among patients treated with linezolid (adjusted HR 1.25, 95% CI 1.07–1.47). Comparable findings were observed in the subgroup analyses. Conclusion Individual clinical outcomes were similar among patients treated for MRSA pneumonia with linezolid compared with vancomycin. A significantly higher rate of the composite outcome of clinical success was observed, however, among patients treated with linezolid compared with vancomycin.

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Linezolid Versus Vancomycin for Methicillin-Resistant Staphylococcus aureus Nosocomial Pneumonia: Controversy Continues

Cited by 15 publications

References 1 publication

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

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

Treatment options for methicillin-resistant Staphylococcus aureus (MRSA) infection: Where are we now?

Comparative Effectiveness of Linezolid and Vancomycin Among a National Veterans Affairs Cohort with Methicillin‐Resistant Staphylococcus aureus Pneumonia

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