title: Salvage treatment for persistent methicillin-resistant Staphylococcus aureus bacteremia: efficacy of linezolid with or without carbapenem.
abstract: 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.
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Hee-Chang
authors: HC
authors: Jang
authors: Sung-Han
authors: SH
authors: Kim
authors: Kye Hyoung
authors: KH
authors: Kim
authors: Choong Jong
authors: CJ
authors: Kim
authors: Shinwon
authors: S
authors: Lee
authors: Kyoung-Ho
authors: KH
authors: Song
authors: Jae Hyun
authors: JH
authors: Jeon
authors: Wan Beom
authors: WB
authors: Park
authors: Hong Bin
authors: HB
authors: Kim
authors: Sang-Won
authors: SW
authors: Park
authors: Nam Joong
authors: NJ
authors: Kim
authors: Eui-Chong
authors: EC
authors: Kim
authors: Myoung-Don
authors: MD
authors: Oh
authors: Kang Won
authors: KW
authors: Choe
mesh_terms: 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
chemical_list: D000081:Acetamides; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D015780:Carbapenems; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid