The role of diabetes mellitus in the treatment of skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus: results from three randomized controlled trials.
OBJECTIVE
To compare outcomes of treating complicated skin and skin structure infections (cSSSI) caused by methicillin-resistant Staphylococcus aureus (MRSA) with linezolid versus vancomycin in diabetic and non-diabetic patients.


METHODS
We pooled data from three prospective clinical trials in which 1056 patients were randomized to receive either linezolid (intravenous (IV) or oral) or vancomycin (IV) every 12h, for 7-28 days.


RESULTS
Diabetic (n=349) and non-diabetic patients (n=707) had comparable demographics and co-morbidities. Clinical success rates were lower in diabetic than in non-diabetic patients (72.3% and 85.8%, respectively). Overall, non-diabetic patients had a shorter adjusted mean length of stay (LOS) compared with diabetic patients (8.2 and 10.7 days, respectively; p<0.0001). Among diabetic patients, rates were comparable with linezolid and vancomycin treatment for clinical success (74% and 71%, respectively) and microbiological success (60% and 54%, respectively). Among non-diabetic patients, clinical and microbiological success rates were higher in linezolid- than in vancomycin-treated patients (90% and 81%, respectively, and 78% and 65%, respectively). Rates of drug-related adverse events were comparable in diabetic and non-diabetic patients and with linezolid and vancomycin treatment. Adjusted mean LOS was shorter with linezolid than with vancomycin treatment in diabetic patients (9.5 and 11.7 days, respectively; p=0.03) and non-diabetic patients (7.6 and 8.9 days, respectively; p=0.02).


CONCLUSIONS
Clinical success rates were lower in diabetic than non-diabetic patients with cSSSI caused by MRSA. Comparing linezolid and vancomycin, clinical and microbiological success rates were comparable in diabetic patients, but were better for linezolid than for vancomycin in non-diabetic patients.
Medical Service, VA Puget Sound Health Care System, 1880 S. Columbian Way (S-111-GIMC), Seattle, WA 98108-1587, USA. balipsky@uw.edu
Benjamin A
BA
Lipsky
Kamal M F
KM
Itani
John A
JA
Weigelt
Warren
W
Joseph
Christopher M
CM
Paap
Arlene
A
Reisman
Daniela E
DE
Myers
David B
DB
Huang
D000081:Acetamides / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D048909:Diabetes Complications / Q000188:drug therapy* / Q000382:microbiology; D017719:Diabetic Foot / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D000069349:Linezolid; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D023303:Oxazolidinones / Q000627:therapeutic use*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013207:Staphylococcal Skin Infections / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*
D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid