Clinical cure and survival in Gram-positive ventilator-associated pneumonia: retrospective analysis of two double-blind studies comparing linezolid with vancomycin.
OBJECTIVE
To assess the effect of baseline variables, including treatment, on clinical cure and survival rates in patients with Gram-positive, ventilator-associated pneumonia (VAP).


METHODS
Retrospective analysis of two randomized, double-blind studies.


METHODS
Multinational study with 134 sites.


METHODS
544 patients with suspected Gram-positive VAP, including 264 with documented Gram-positive VAP and 91 with methicillin-resistant S. aureus (MRSA) VAP.


METHODS
Linezolid 600 mg or vancomycin 1 g every 12 h for 7-21 days, each with aztreonam.


RESULTS
Clinical cure rates assessed 12-28 days after the end of therapy and excluding indeterminate or missing outcomes significantly favored linezolid in the Gram-positive and MRSA subsets. Logistic regression showed that linezolid was an independent predictor of clinical cure with odds ratios of 1.8 for all patients, 2.4 for Gram-positive VAP, and 20.0 for MRSA VAP. Kaplan-Meier survival rates favored linezolid in the MRSA subset. Logistic regression showed that linezolid was an independent predictor of survival with odds ratios of 1.6 for all patients, 2.6 for Gram-positive VAP, and 4.6 for MRSA VAP.


CONCLUSIONS
Initial linezolid therapy was associated with significantly better clinical cure and survival rates than was initial vancomycin therapy in patients with MRSA VAP.
Kollef
Marin H
MH
Pulmonary and Critical Care Division, Department of Internal Medicine, School of Medicine, Washington University, 660 South Euclid Avenue, St. Louis, MO 63110, USA. kollefm@msnotes.wustl.edu
Rello
Jordi
J
Cammarata
Sue K
SK
Croos-Dabrera
Rodney V
RV
Wunderink
Richard G
RG
D000081:Acetamides / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006801:Humans; D000069349:Linezolid; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D023303:Oxazolidinones / Q000627:therapeutic use*; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D014640:Vancomycin / Q000627:therapeutic use*
D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid