TITLE:
Linezolid versus Vancomycin for the Treatment of Methicillin-Resistant Staphylococcus aureus in Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia at Tertiary Care Hospital
AUTHORS:
Eman Mohammad Hamdan, Majda Al-Attas
KEYWORDS:
Linezolid, Vancomycin, Pneumonia, Methicillin-Resistant Staphylococcus aureu
JOURNAL NAME:
Advances in Infectious Diseases,
Vol.7 No.1,
March
1,
2017
ABSTRACT: Aim: To evaluate morbidity and mortality rate, clinical cure rate and cost of
linezolid versus vancomycin in patients who have hospital-acquired pneumonia
(HAP), ventilator-associated pneumonia (VAP) or Healthcare-associated pneumonia (HCAP) caused by methicillin-resistant Staphylococcus aureus (MRSA). Methods: Retrospective
analysis data. Data were collected for adult patients
admitted to King Faisal Specialist Hospital and Research Centre-Jeddah (KFSH & RC-J) from January 2010 to May 2015. Method: A
total of 88 patients with HAP, VAP and HCAP caused by MRSA
treated with vancomycin (IV) or linezolid (IV or PO) either as empirically or
directed therapy ≥ 7 days. They are
retrospectively evaluated and analyzed. The primary end points are
morbidity and mortality rate as well as clinical cure rate. The secondary end
point is the cost analysis for each medication. Results: A total of 40
patients (ICU, n = 13 (32.5% and non ICU, n = 27 (67.5%)) were included in the
study. Among vancomycin, n = 21 (52.5%); age (54.95 ± 18.255) and linezolid, n = 19 (74.5%); age (48.684 ± 25.593), there was no
statistical differences in mortality and morbidity rate (P = 0.375).
Clinical cure rate (fever improvement, 12 (57.1%) vs 12 (63.2%); P = 0.698,
leukocytosis improvement, 15 (71.4%) vs 14 (73.7%); P = 0.873, purulent sputum
improvement, 6 (28.6%) vs 4 (21.1%); P = 0.429, dyspnea improvement, 8 (38.1%) vs 3 (15.8%); P =
0.115,cough improvement 4 (19.0%) vs 4 (21.1%); P = 0.592,
microbiological eradication of MRSA from sputum culture, 2 (9.5%) vs 6 (31.6%); P = 0.089 and improvement of
radiographic finding (pulmonary infiltration), 17 (81.0%) vs 16 (84.2%); P = 0.559) of vancomycin vs linezolid, respectively. The cost analysis in the treatment of MRSA
pneumonia with linezolid is statistical significantly higher than vancomycin. The mean cost of vancomycin = 185.9143 SR and of linezolid = 4547.3684 SR (P Conclusion: There are no statistical differences in mortality and morbidity rate and
clinical cure rate between linezolid and vancomycin in the treatment of MRSA in
HAP, VAP, and HCAP. However, the cost of linezlid is significantly higher than
vancomycin during the treatment period of one patient.