title: Evaluation of the treatment of methicillin-resistant Staphylococcus aureus bacteremia.
abstract: BACKGROUND
  Bloodstream infections are a leading cause of death in the United States. Methicillin-resistant Staphylococcus aureus (MRSA) encompasses >50% of all S aureus strains in infected hospitalized patients and increases mortality, length of stay and healthcare costs. The objective of this study was to evaluate the treatment of MRSA bacteremia with daptomycin, linezolid and vancomycin.
  
  
  METHODS
  Patients with MRSA bacteremia between June 2008 and November 2010 were reviewed retrospectively. A microbiology laboratory report identified patients with ≥ 1 positive MRSA blood culture. Patients ≥ 18 years receiving daptomycin, linezolid or vancomycin for ≥ 7 consecutive days were included. Polymicrobial blood cultures and patients treated concomitantly with >1 anti-MRSA agent were excluded.
  
  
  RESULTS
  Of 122 patients included, 53 received daptomycin, 15 received linezolid and 54 received vancomycin. Clinical and microbiologic cure rates were similar between daptomycin, linezolid and vancomycin (58.5% versus 60% versus 61.1%; 93.6% versus 100% versus 90%, respectively). Thirteen patients (daptomycin 4/24 versus linezolid 1/9 versus vancomycin 8/49, P = 0.5960) had recurrence while 12 patients had re-infection (daptomycin 5/42 versus linezolid 0/9 versus vancomycin 7/49, P = 0.4755). Treatment failure occurred in 11 patients treated with daptomycin, 4 with linezolid and 9 with vancomycin (P = 0.662). Compared with daptomycin and vancomycin, linezolid-treated patients had higher mortality (P = 0.0186).
  
  
  CONCLUSIONS
  No difference in clinical or microbiologic cure rates was observed between groups. Daptomycin and vancomycin appear equally efficacious for MRSA bacteremia, whereas linezolid therapy was associated with higher mortality.
authors.affiliation: Department of Pharmacy (JBU, NHV, CKF, THS), Methodist University Hospital, and University of Tennessee Health Science Center, Department of Medicine (KOC, MSG), Department of Clinical Pharmacy (JBU, NV, CKF, THS), Memphis, TN.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Usery
authors.forename: Ngan H
authors.initials: NH
authors.lastname: Vo
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Finch
authors.forename: Kerry O
authors.initials: KO
authors.lastname: Cleveland
authors.forename: Michael S
authors.initials: MS
authors.lastname: Gelfand
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Self
mesh_terms: D000081:Acetamides / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000191:economics; D017576:Daptomycin / Q000191:economics / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D000069349:Linezolid; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D023303:Oxazolidinones / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D013714:Tennessee / Q000453:epidemiology; D016896:Treatment Outcome; D014640:Vancomycin / Q000191:economics / Q000627:therapeutic use
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid; D017576:Daptomycin