Original Contribution
Linezolid versus vancomycin for nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus in the elderly: A retrospective cohort analysis: Effectiveness of linezolid in the elderly

https://doi.org/10.1016/j.ajem.2016.10.058Get rights and content

Abstract

Objectives

Several reports have compared the efficacy of linezolid (LZD) in Methicillin-resistant Staphylococcus aureus (MRSA) infections with that of vancomycin (VCM); however, these two antibiotics for the treatment of nosocomial MRSA pneumonia in elderly patients has not been well evaluated. The purpose of this study is to evaluate the efficacy and safety of LZD compared with VCM for the treatment of elderly patients with nosocomial MRSA pneumonia in a retrospective chart review of a cohort.

Methods

We included 28 consecutive patients aged ≥ 65 years hospitalized with a confirmed diagnosis of MRSA pneumonia and treated with LZD (n = 11) or VCM (n = 17) between November 2010 and May 2015. We collected patient, disease, and laboratory data. The primary outcome was 30-day mortality. The secondary outcomes were the sequential organ failure assessment (SOFA) total, respiratory, renal, coagulation, hepatic, cardiovascular, and central nervous system scores on days 1, 3, 7, and 14.

Results

There were no significant differences between the two groups with regard to baseline characteristics. The 30-day mortality rate was significantly lower in the LZD group than in the VCM group (0% vs. 41%, P = .02). The SOFA total score on days 3, 7, and 14 were significantly lower those at baseline in the LZD group (P < .05). The SOFA respiratory score on days 14 was also significantly lower than baseline in the LZD group (P < .05).

Conclusion

LZD may be more efficacious than VCM for treating elderly patients with nosocomial MRSA pneumonia.

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.

Section snippets

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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    1

    Drs. Takada and Hifumi contributed equally to this work.

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