Efficacy of linezolid-based salvage therapy compared with glycopeptide-based therapy in patients with persistent methicillin-resistant Staphylococcus aureus bacteremia.
OBJECTIVE
We evaluated the efficacy of linezolid-based salvage therapy compared with glycopeptide-based therapy in patients with persistent (≥7 days) methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B).


METHODS
All patients with MRSA-B during 2-year period at a tertiary-care hospital were prospectively enrolled. Linezolid-based salvage therapy was classified if patients switched glycopeptides to linezolid with/without carbapenem due to persistent MRSA-B. Covariate adjustment using the propensity score and inverse probability of treatment weighting (IPTW) using the propensity score were performed to control for bias in treatment assignment.


RESULTS
Of 377 patients with MRSA-B, 90 with persistent MRSA-B were included. Of these, 38 (42%) were classified as linezolid-based salvage group and the remaining 52 (58%) as glycopeptide-based therapy group. The duration of persistent bacteremia (median 16 days vs. 10 days; P = 0.008) was longer in linezolid-based salvage group than in the comparator. However, the 30-day mortality (11% vs. 25%; P = 0.08) had a trend toward being lower in linezolid-based salvage group than those in the comparator. Logistic regression models with covariate adjustment and IPTW using propensity scores also revealed that linezolid-based salvage showed a trend toward having better outcome than the comparator, although this did not reach any statistically significance (OR 0.31; 95% CI 0.03-2.95 and OR 0.19; 95% CI 0.01-3.39, respectively).


CONCLUSIONS
While having worse prognostic factors compared with glycopeptide-based therapy, linezolid-based salvage therapy revealed a trend toward better outcomes than the comparator. Our data suggest that linezolid-based salvage therapy would be considered in patients with persistent MRSA-B despite the use of glycopeptides therapy.
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Hyun Jung
HJ
Park
Sung-Han
SH
Kim
Min-Ju
MJ
Kim
Yu-Mi
YM
Lee
So-Youn
SY
Park
Song Mi
SM
Moon
Ki-Ho
KH
Park
Yong Pil
YP
Chong
Sang-Oh
SO
Lee
Sang-Ho
SH
Choi
Jun Hee
JH
Woo
Yang Soo
YS
Kim
D000081:Acetamides / Q000494:pharmacology / Q000627:therapeutic use*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006020:Glycopeptides / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D000069349:Linezolid; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016017:Odds Ratio; D023303:Oxazolidinones / Q000494:pharmacology / Q000627:therapeutic use*; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
D000081:Acetamides; D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D023303:Oxazolidinones; D000069349:Linezolid