Linezolid versus vancomycin for the treatment of suspected methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a systematic review employing meta-analysis

Wang, Yan; Zou, Yamin; Xie, Jiao; Wang, Taotao; Zheng, Xiaowei; He, Hairong; Dong, Weihua; Xing, Jianfeng; Dong, Yalin

doi:10.1007/s00228-014-1775-x

Cited by 45 publications

(39 citation statements)

References 38 publications

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“…A meta‐analysis included nine randomized trials and more than 4000 patients; the authors found no statistical difference between linezolid and vancomycin therapy on mortality or clinical response . Another meta‐analysis that included nine randomized trials involving nearly 3000 patients found linezolid to be comparable with vancomycin for clinical cure in treating nosocomial pneumonia, including those cases caused by MRSA . Using a national health system database, a study compared the effectiveness of linezolid with that of vancomycin in more than 5000 adult patients .…”

Section: Discussionmentioning

confidence: 99%

“…10 Another meta-analysis that included nine randomized trials involving nearly 3000 patients found linezolid to be comparable with vancomycin for clinical cure in treating nosocomial pneumonia, including those cases caused by MRSA. 11 Using a national health system database, a study compared the effectiveness of linezolid with that of vancomycin in more than 5000 adult patients. 6 The investigators observed similar individual clinical outcomes among MRSA pneumonia patients treated with linezolid compared with those treated with vancomycin but found linezolid-treated patients to have a higher composite outcome of clinical success.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Linezolid and Vancomycin for Methicillin-ResistantStaphylococcus aureusPneumonia: Institutional Implications

et al. 2016

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Objective Recent studies suggesting clinical superiority of linezolid over vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia led to a change in our institution’s clinical pathway/order form for hospital-acquired pneumonia, positioning linezolid as the preferred agent. Our objective was to assess the impact of this change within our institution. Design Retrospective electronic medical records review Methods The analysis for this observational study included eligible patients admitted to our medical center between May 1, 2011 and August 31, 2014 , with ICD-9 codes for MRSA and pneumonia. Included patients were at least 18 years of age and had vancomycin or linezolid initiated at least 2 days after admission and continued for at least 2 consecutive days. The primary endpoints were extent of antibiotic use before and after order form change and length of stay (LOS) and hospital charges in the two treatment groups. A secondary aim was to detect any gross discrepancies in patient outcomes such as treatment duration, mechanical ventilation duration, all-cause mortality rate, nephrotoxicity, and 30-day readmission between the two treatment groups. Measurements and Main Results Outcomes in 227 patients were assessed. Linezolid use increased 16.2% subsequent to the change in the order form. Although not statistically significant, the median hospital admission charge was $6,200 lower in patients treated with linezolid compared with those treated with vancomycin ($25,900 vs. $32,100). Hospital LOS was significantly associated with Charlson comorbidity index (P < 0.001), the type of treatment (p = 0.032), duration of treatment (p < 0.001), mechanical ventilation (p < 0.001), and ICU admission (p < 0.001). All-cause mortality favored linezolid treatment and these patients were more likely to be discharged (shorter LOS). Conclusions Although linezolid use increased markedly with this pathway/order form change, no negative institutional consequences or unfavorable patient outcomes were detected, justifying the change in policy from these perspectives.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Linezolid and Vancomycin for Methicillin-ResistantStaphylococcus aureusPneumonia: Institutional Implications

et al. 2016

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“…One study demonstrated the advantage of linezolid over vancomycin in the therapy of staphylococci-based nosocomial-acquired pneumonia [ 37 ]. However, other studies reported no decisive benefit of linezolid over vancomycin for treating MRSA nosocomial-acquired pneumonia [ 38 , 39 ]. There are still different recommendations for the management of MRSA pneumonia.…”

Section: Discussionmentioning

confidence: 99%

No Outbreak of Vancomycin and Linezolid Resistance in Staphylococcal Pneumonia over a 10-Year Period

2015

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BackgroundStaphylococci can cause wound infections and community- and nosocomial-acquired pneumonia, among a range of illnesses. Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) have been rapidly increasing as a cause of infections worldwide in recent decades. Numerous reports indicate that S. aureus and MRSA are becoming resistant to many antibiotics, which makes them very dangerous. Therefore, this study retrospectively investigated the resistance to antimicrobial agents in all hospitalized patients suffering from community- or nosocomial-acquired pneumonia due to S. aureus and MRSA.MethodsInformation from the study groups suffering from either community- or nosocomial-acquired pneumonia caused by S. aureus or MRSA was gathered by searching records from 2004 to 2014 at the HELIOS Clinic Wuppertal, Witten/Herdecke University, Germany. The findings of antibiotic resistance were analyzed after the evaluation of susceptibility testing for S. aureus and MRSA.ResultsTotal of 147 patients (63.9%, 95% CI 57.5%–69.8%), mean age 67.9 ± 18.5 years, with pneumonia triggered by S. aureus, and 83 patients (36.1%, 95% CI 30.2%–42.5%), mean age 72.3 ± 13.8 years, with pneumonia due to MRSA. S. aureus and MRSA developed no resistance to vancomycin (P = 0.019 vs. < 0.0001, respectively) or linezolid (P = 0.342 vs. < 0.0001, respectively). MRSA (95.3%) and S. aureus (56.3%) showed a high resistance to penicillin. MRSA (87.7%) was also found to have a high antibiotic resistance against ß-lactam antibiotics, compared to S. aureus (9.6%). Furthermore, MRSA compared to S. aureus, respectively, had increased antibiotic resistance to ciprofloxacin (90.1% vs. 17.0%), cefazolin (89.7% vs. 10.2%), cefuroxime (89.0% vs. 9.1%), levofloxacin (88.2% vs. 18.4%), clindamycin (78.0% vs. 14.7%), and erythromycin (76.5% vs. 20.8%).ConclusionNo development of resistance was found to vancomycin and linezolid in patients with pneumonia caused by S. aureus and MRSA.

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“…MRSA nosocomial pneumonia is generally treated with systemic vancomycin or linezolid, but therapeutic responses are unsatisfactory [3]. Furthermore, antibiotic-associated adverse effects are problematic.…”

Section: Introductionmentioning

confidence: 99%

Pilot Study of Aerosolised Plus Intravenous Vancomycin in Mechanically Ventilated Patients with Methicillin-Resistant Staphylococcus Aureus Pneumonia

Cho

Kim

Yang

et al. 2020

JCM

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Treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in critically ill patients remains unsatisfactory. This pilot study aimed to evaluate the clinical outcomes of aerosolised vancomycin in addition to intravenous administration in this setting. This was a prospective, noncomparative, phase II trial. Patients receiving mechanical ventilation for >48 h in intensive care units (ICUs) were screened; those receiving intravenous vancomycin for MRSA pneumonia were enrolled. Patients received aerosolised vancomycin (250 mg every 12 h for five days) via a vibrating mesh nebuliser. The primary outcome was treatment success (clinical cure or improvement) at the conclusion of antibiotic treatment. Vancomycin concentrations were measured in bronchoalveolar lavage fluid according to administration time. Twenty patients were enrolled (median age 75 years and 13 (65%) men; 18 (90%) cases with nosocomial pneumonia). Thirteen patients (65%) showed clinical cure or improvement. Microbiological eradication of MRSA was confirmed in 14 patients (70%). ICU and hospital mortality rates were 30% and 35%, respectively. Maximum aerosolised vancomycin concentration was observed 4-5 h after nebulising (98.75 ± 21.79 mcg/mL). No additional systemic adverse effects occurred following aerosol vancomycin treatment. Aerosolised vancomycin combination therapy may be an alternative treatment for patients with severe MRSA pneumonia receiving mechanical ventilation (ClinicalTrials.gov number, NCT01925066).

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Linezolid versus vancomycin for the treatment of suspected methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a systematic review employing meta-analysis

Abstract: These results suggest that linezolid is not superior to vancomycin with respect to both clinical and microbiological cure rates in patients with MRSA NP.

Cited by 45 publications

References 38 publications

Comparison of Linezolid and Vancomycin for Methicillin-ResistantStaphylococcus aureusPneumonia: Institutional Implications

Comparison of Linezolid and Vancomycin for Methicillin-ResistantStaphylococcus aureusPneumonia: Institutional Implications

No Outbreak of Vancomycin and Linezolid Resistance in Staphylococcal Pneumonia over a 10-Year Period

Pilot Study of Aerosolised Plus Intravenous Vancomycin in Mechanically Ventilated Patients with Methicillin-Resistant Staphylococcus Aureus Pneumonia

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