Salvage treatment for persistent methicillin-resistant Staphylococcus aureus bacteremia: efficacy of linezolid with or without carbapenem.
BACKGROUND
Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with high mortality rates, but no treatment strategy has yet been established. We performed this study to evaluate the efficacy of linezolid with or without carbapenem in salvage treatment for persistent MRSA bacteremia.


METHODS
All adult patients with persistent MRSA bacteremia for 7 days from January 2006 through March 2008 who were treated at Seoul National University Hospital were studied. The results of linezolid salvage therapy with or without carbapenem were compared with those of salvage therapy with vancomycin plus aminoglycosides or rifampicin.


RESULTS
Thirty-five patients with persistent MRSA bacteremia were studied. The early microbiological response (ie, negative results for follow-up blood culture within 72 hours) was significantly higher in the linezolid-based salvage therapy group than the comparison group (75% vs 17%; P =.006). Adding aminoglycosides or rifampicin to vancomycin was not successful in treating any of the patients, whereas linezolid-based therapy gave an 88% salvage success rate P =.001). The S. aureus-related mortality rate was lower for patients treated with a linezolid salvage regimen than for patients continually treated with a vancomycin-based regimen (13% vs 53%; P =.030).


CONCLUSIONS
Linezolid-based salvage therapy effectively eradicated S. aureus from the blood for patients with persistent MRSA bacteremia. The salvage success rate was higher for linezolid therapy than for vancomycin-based combination therapy.
Jang
Hee-Chang
HC
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Kim
Sung-Han
SH
Kim
Kye Hyoung
KH
Kim
Choong Jong
CJ
Lee
Shinwon
S
Song
Kyoung-Ho
KH
Jeon
Jae Hyun
JH
Park
Wan Beom
WB
Kim
Hong Bin
HB
Park
Sang-Won
SW
Kim
Nam Joong
NJ
Kim
Eui-Chong
EC
Oh
Myoung-Don
MD
Choe
Kang Won
KW
D000081:Acetamides / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D015780:Carbapenems / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D007723:Korea; D000069349:Linezolid; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008875:Middle Aged; D023303:Oxazolidinones / Q000627:therapeutic use; D016879:Salvage Therapy / Q000379:methods*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use; D055815:Young Adult
D000081:Acetamides; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D015780:Carbapenems; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid