title: Vancomycin versus linezolid in the treatment of methicillin-resistant Staphylococcus aureus meningitis.
abstract: BACKGROUND
  Vancomycin is the mainstay of treatment for methicillin-resistant Staphylococcus aureus (MRSA) meningitis. However, successful outcomes with linezolid have not been reported in a large series of patients. We conducted a single-center retrospective cohort study to compare vancomycin with linezolid in the treatment of MRSA meningitis.
  
  
  METHODS
  We extracted data and outcomes for all adult patients (age >18 years) with culture-proved MRSA meningitis who received vancomycin or linezolid between January 2006 and June 2011. A definite diagnosis of meningitis was based on the isolation of MRSA in at least one cerebrospinal fluid (CSF) culture and findings in CSF that are typical of the infection. Linezolid was given intravenously (IV) at a dosage of 600 mg q12h and vancomycin IV at 500 mg q6h.
  
  
  RESULTS
  A total of 8 patients with MRSA meningitis (5 male, 3 female; age [mean±SD] 61.6±13.2 years) received vancomycin and 9 patients (7 male, 2 female; age 59.1±15.6 years) received linezolid. All isolated strains of MRSA were susceptible to both vancomycin and linezolid. The rates of microbiologic success with linezolid or vancomycin, in terms of clearance of MRSA from CSF on day 5, were 7/9 and 2/8 (p=0.044, Fisher exact test). No severe adverse events occurred in either treatment arm of the study. One-month survival of the patients in whom treatment was successful microbiologically was 2/2 in the vancomycin-treated group and 4/7 in the linezolid-treated group. Minimum inhibitory concentration (MIC) data for vancomycin were available for 5/6 treatment failures with vancomycin, and vancomycin MIC values of these five strains were 2 mg/L.
  
  
  CONCLUSIONS
  Analysis of the findings in the limited cohorts in our study suggests that linezolid is superior to vancomycin for treating MRSA meningitis, especially in cases in which there is a high MIC (2 mg/L) for vancomycin. A clinical study involving larger cohorts may increase the evidence available in relation to this question.
authors.affiliation: Ege University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey 35100. oguz.resat.sipahi@ege.edu.tr
authors.forename: Oguz Resat
authors.initials: OR
authors.lastname: Sipahi
authors.forename: Selin
authors.initials: S
authors.lastname: Bardak-Ozcem
authors.forename: Tuncer
authors.initials: T
authors.lastname: Turhan
authors.forename: Bilgin
authors.initials: B
authors.lastname: Arda
authors.forename: Mete
authors.initials: M
authors.lastname: Ruksen
authors.forename: Husnu
authors.initials: H
authors.lastname: Pullukcu
authors.forename: Sohret
authors.initials: S
authors.lastname: Aydemir
authors.forename: Tayfun
authors.initials: T
authors.lastname: Dalbasti
authors.forename: Taskin
authors.initials: T
authors.lastname: Yurtseven
authors.forename: Hilal
authors.initials: H
authors.lastname: Sipahi
authors.forename: Mehmet
authors.initials: M
authors.lastname: Zileli
authors.forename: Sercan
authors.initials: S
authors.lastname: Ulusoy
mesh_terms: D000081:Acetamides / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D000069349:Linezolid; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D023303:Oxazolidinones / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid