title: Linezolid and vancomycin in treatment of lower-extremity complicated skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus in patients with and without vascular disease.
abstract: BACKGROUND
  We evaluated drug efficacy and safety among patients with and without vascular disease who were treated with linezolid or vancomycin for a lower-extremity complicated skin and skin structure infection (cSSSI) caused by methicillin-resistant Staphylococcus aureus (MRSA).
  
  
  METHODS
  We pooled data from two randomized clinical trials evaluating the efficacy and safety of linezolid 600 mg intravenously (IV) or orally every 12 h and vancomycin 15 mg/kg or 1 g IV every 12 h for the treatment of cSSSI caused by culture-proved MRSA.
  
  
  RESULTS
  There were 477 patients for analysis. Among patients with vascular disease (linezolid n=139, vancomycin n=135), the clinical success rate was 80.4% and 66.7% (p=0.02) for patients treated with linezolid and vancomycin, respectively. Among patients without vascular disease (linezolid n=91, vancomycin n=112), the clinical success rate was 94.5% and 89.4%, respectively (p=0.24). Linezolid-treated patients had fewer IV catheter-site complications and less kidney impairment but more frequent thrombocytopenia than those who received vancomycin, regardless of the presence or absence of vascular disease.
  
  
  CONCLUSIONS
  Linezolid is an effective treatment for patients with and without vascular disease who have a lower-extremity cSSSI caused by MRSA. The safety data were consistent with the known safety profiles of linezolid and vancomycin given for this indication.
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA. tmduane@vcu.edu
authors.forename: Therèse M
authors.initials: TM
authors.lastname: Duane
authors.forename: John A
authors.initials: JA
authors.lastname: Weigelt
authors.forename: Laura A
authors.initials: LA
authors.lastname: Puzniak
authors.forename: David B
authors.initials: DB
authors.lastname: Huang
mesh_terms: D000081:Acetamides / Q000008:administration & dosage* / Q000009:adverse effects; D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D000069349:Linezolid; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D023303:Oxazolidinones / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D013207:Staphylococcal Skin Infections / Q000188:drug therapy*; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects; D014652:Vascular Diseases / Q000150:complications*
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid