Original ContributionLinezolid versus vancomycin for nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus in the elderly: A retrospective cohort analysis: Effectiveness of linezolid in the elderly
Introduction
Among hospital-acquired infections, nosocomial pneumonia is the leading cause of death, with estimates of mortality ranging from 20% to 50% [1], [2], [3], [4]. The clinical characteristics of pneumonia differ substantially between elderly and younger patients [5], and with the rapid aging of society, increasing numbers of elderly patients are experiencing nosocomial pneumonia. However, details of nosocomial pneumonia in the elderly remain unknown and need to be investigated.
Methicillin-resistant Staphylococcus aureus (MRSA) now accounts for 20%–40% of all nosocomial pneumonias [6], [7]. The Clinical Practice Guidelines of the Infectious Diseases Society of America [8] recommend linezolid (LZD) and vancomycin (VCM) as first-line therapy for nosocomial MRSA pneumonia. Several reports have compared the efficacy of LZD in MRSA infections with that of VCM [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]. Wunderink et al. combined and analyzed the results of two RCTs comparing LZD with VCM in patients with nosocomial MRSA pneumonia (approximately 70% of whom were older than 65 years) [11], [13] and concluded that initial therapy with LZD was associated with significantly better survival and clinical cure rates than was VCM in these patients [16]; however, these two antibiotics for the treatment of nosocomial MRSA pneumonia limited to elderly patients has not been well evaluated.
The objective of the present study was to evaluate the efficacy and safety of LZD for the treatment of elderly patients with nosocomial MRSA pneumonia in a retrospective chart review of a cohort. VCM was chosen as the comparator as it is the global standard therapeutic drug for MRSA pneumonia.
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Study Design and Setting
This single-center retrospective cohort study, which was performed by the review of medical records, was conducted at the National Hospital Organization Disaster Medical Center, a 455-bed academic teaching institution and with 34 ICU beds. It was approved by the center's institutional review board and was conducted in accordance with the ethical standards established in the 1964 Declaration of Helsinki and its later amendments. The requirement for patient consent was waived due to the
Baseline Characteristics
In total, 28 patients were included: 11 patients were treated with LZD (the LZD group) and 17 with VCM (the VCM group). The baseline characteristics of the two groups are shown in Table 1. There were no significant differences between the two groups with regard to age, sex, BMI, baseline diseases, laboratory data, baseline SOFA scores, or ICU admission rate.
Effect of Treatment on 30-Day Mortality
The 30-day mortality rates were 0% (0 of 11 patients) and 41% (7 of 17 patients) in the LZD and VCM groups, respectively (P = .02).
Effect of Treatment on SOFA Total Scores
The serial
Discussion
The results of the present study suggest that LZD administration may improve mortality in patients with nosocomial MRSA pneumonia in the elderly as demonstrated by the 30-day mortality rates and the significant improvement in the organ dysfunction scores.
Several meta-analyses have compared LZD with VCM for the treatment of nosocomial MRSA pneumonia but found no differences in mortality [10], [23]. In a recent RCT that compared LZD with VCM for the treatment of nosocomial MRSA pneumonia,
Conclusion
In conclusion, we found that LZD administration may improve mortality in elderly patients with nosocomial MRSA pneumonia as demonstrated by reduced 30-day mortality and significant reductions in SOFA scores.
Acknowledgments
We are grateful to all physicians and nurses at the study site for their crucial contribution to the successful completion of this study.
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Cited by (12)
Meta-analysis of vancomycin versus linezolid in pneumonia with proven methicillin-resistant Staphylococcus aureus
2021, Journal of Global Antimicrobial ResistanceCitation Excerpt :The mortality extracted from the five RCTs [13,15–18] did not significantly differ between VCM and LZD (RR = 1.08, 95% CI = 0.88–1.32, heterogeneity P = 0.215, Egger test P = 0.268, Fig. 1A). Similarly, the mortality in CSs did not show significant benefit in patients treated with VCM compared with those treated with LZD [19–26] (OR = 1.20, 95% CI = 0.94–1.53, heterogeneity P = 0.456, Egger test P = 0.219, Fig. 1B). No publication bias was detected.
Low penetrance of antibiotics in the epithelial lining fluid. The role of inhaled antibiotics in patients with bronchiectasis
2020, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :Cefepime has been considered one of the beta-lactams with regards to concentration in ELF [18]. Macrolides and oxazolidinones have been established as antibiotics with higher concentration in ELF than serum [19–29]. Among quinolones, levofloxacin and moxifloxacin presented with higher concentration in ELF than ciprofloxacin [22,30–33].
Daily practice and prognostic factors for pneumonia caused by methicillin-resistant Staphylococcus aureus in Japan: A multicenter prospective observational cohort study
2020, Journal of Infection and ChemotherapyCitation Excerpt :Although we were unable to evaluate all of these factors in our study population, our findings partially agreed with the abovementioned studies, including the association between increased disease severity at presentation and increased mortality. In this study, the rates of clinical failure and mortality were slightly higher but were within the range specified in previous studies [16,31–35]. One reason for this may be that the patients in this study were relatively old, with a mean age of 77 years.
The authors respond
2017, American Journal of Emergency MedicineLinezolid versus vancomycin in Methicillin Resistant Staphylococcus aureus nosocomial pneumonia in the elderly
2017, American Journal of Emergency Medicine
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Drs. Takada and Hifumi contributed equally to this work.