[Comparison of teicoplanin and linezolid therapies in patients with methicillin-resistant Staphylococcus aureus pneumonia acquired from respiratory intensive care unit].
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the high-risk and potential multi-drug resistant microorganisms that leads to infection in intensive care unit (ICU). Although standard antibiotics used for its treatment are glycopeptides, linezolid is considered as an alternative treatment especially in hospital-acquired pneumonia (HAP). The aim of this retrospective study was to compare the results of linezolid and teicoplanin treatments in patients with MRSA isolated from their respiratory samples in ICU. In our respiratory ICU, 41 consecutive patients (28 males, mean age 66.0 ± 16.0 years) diagnosed as HAP due to MRSA were included in the study. Teicoplanin was used in 22 patients and linezolid treatment was given to 19 patients. In the linezolid group, mean age and Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II score were found higher (68.9 ± 12.5 vs. 63.5 ± 18.5 and 25.7 ± 6.4 vs. 23.2 ± 4.9, respectively), and PaO2/FiO2 ratio was lower (176.4 ± 58.2 vs. 191.6 ± 91.3) however, the differences between the two groups were not statistically significant. There was no difference between the two groups in terms of hospitalization indications, co-morbid diseases, other baseline findings and risk factors for development of HAP caused by MRSA. Invasive mechanical ventilation was applied to 86.4% of the patients in teicoplanin group and 84.2% in linezolid group (p> 0.05). The rates of bacteremia were found as 22.7% and 31.6% in teicoplanin and linezolid groups, respectively (p>0.05). Bacteriological eradication was achieved in all patients given linezolid, whereas this rate was 72.7% in patients on teicoplanin therapy (p= 0.048). There was no difference with regards to durations of ICU and hospital stay between the two groups. The mortality rate was found lower in the linezolid group than the teicoplanin group (42.1% vs. 63.6%), however this difference was not found statistically important (p> 0.05). In conclusion; the present study demonstrated that better microbiological eradication was achieved by linezolid therapy in pneumonia caused by MRSA in ICU, however, the clinical efficacy and survival rates were similar to teicoplanin therapy.
Ege Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, İzmir, Türkiye. sezai72000@yahoo.com
Mehmet Sezai
MS
Taşbakan
Pervin
P
Korkmaz Ekren
Hüsnü
H
Pullukçu
Burcu
B
Başarık
Alev
A
Susur
Söhret
S
Aydemir
Ozen Kaçmaz
OK
Başoğlu
Feza
F
Bacakoğlu
D018806:APACHE; D000081:Acetamides / Q000627:therapeutic use*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D000069349:Linezolid; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D008875:Middle Aged; D023303:Oxazolidinones / Q000627:therapeutic use*; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy* / Q000382:microbiology; D012124:Respiratory Care Units; D012189:Retrospective Studies; D017334:Teicoplanin / Q000627:therapeutic use*
D000081:Acetamides; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D017334:Teicoplanin; D000069349:Linezolid