Clinical and economic outcomes of oral linezolid versus intravenous vancomycin in the treatment of MRSA-complicated, lower-extremity skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus.
BACKGROUND
Resistant bacteria often complicate the management of skin and soft tissue infections of the lower extremities. This open-label study compared oral linezolid and intravenous vancomycin for management of complicated skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA).


METHODS
Patients aged 18 years or older with proven MRSA-related complicated skin and soft-tissue infections requiring surgical intervention were randomized to receive oral linezolid (n=30) or intravenous vancomycin (n=30) for 7 to 21 days. Clinical and microbiological outcomes, duration of hospitalization and drug treatment, and outpatient charges were determined.


RESULTS
Linezolid was associated with greater rates of clinical cure and improvement (P=.015), a 3-day shorter median length of stay (P=.003), and reduced outpatient charges (P<.001). Vancomycin therapy was associated with more treatment failures and subsequent lower-extremity amputations (P=.011).


CONCLUSIONS
Clinical outcomes were significantly better with linezolid than with vancomycin. Additionally, linezolid was associated with reduced length of stay and outpatient charges.
Sharpe
J Neal
JN
SharpCare, LLC, 9505 Williamsburg Plaza, Suite 201, Louisville, KY 40222, USA. drjneal@msn.com
Shively
Eugene H
EH
Polk
Hiram C
HC
D000081:Acetamides / Q000008:administration & dosage* / Q000191:economics; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D000069349:Linezolid; D035002:Lower Extremity; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D023303:Oxazolidinones / Q000008:administration & dosage* / Q000191:economics; D011336:Probability; D012016:Reference Values; D012720:Severity of Illness Index; D016037:Single-Blind Method; D012874:Skin Diseases, Infectious / Q000188:drug therapy* / Q000382:microbiology; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D016896:Treatment Outcome; D014481:United States; D014640:Vancomycin / Q000008:administration & dosage* / Q000191:economics
D000081:Acetamides; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid