title: Oral Antimicrobial Therapy: Efficacy and Safety for Methicillin-Resistant Staphylococcus aureus Infections and Its Impact on the Length of Hospital Stay.
abstract: BACKGROUND
  Carefully switching from intravenous to oral antibiotic therapy has shown to reduce treatment costs and lengths of hospital stay as well as increase safety and comfort in patients with infections. The aim of this study was to compare the clinical efficacy and safety between the patients treated with glycopeptides (case group), and the patients given oral antibiotics, as the initial or step-down therapy (control group), in the treatment of patients with methicillin-resistant Staphylococcus aureus (MRSA) infection.
  
  
  METHODS
  A multicenter observational study was retrospectively performed in 7 teaching hospitals in Korea from January to December 2012. The study included adult patients (≥ 18 years) with infection caused by MRSA isolates, susceptible to clindamycin, erythromycin, and ciprofloxacin. The primary end point was treatment outcome, including all-cause mortality and switching of antibiotics. Drug-related adverse events and the lengths of hospital stay were also compared between the two treatment groups.
  
  
  RESULTS
  During the study period, 107 patients (43 cases and 64 controls) with MRSA infections were enrolled from the participating hospitals. The most common sites of MRSA infection were skin and soft tissue (n = 28) and bone and joint (n = 26). The median Charlson comorbidity index (P = 0. 560), the frequency of severe sepsis (P = 0.682) or thrombocytopenia (P = 1.000), and median level of serum C-reactive protein (P = 0.157) at the onset of MRSA infections were not significantly different between the case and control groups. The oral antibiotics most frequently prescribed in the case group, were fluoroquinolones (n = 29) and clindamycin (n = 8). The median duration of antibiotic treatment (P = 0.090) and the occurrence of drug-related adverse events (P = 0.460) did not reach statistically significant difference between the two groups, whereas the total length of hospital stay after the onset of MRSA infection was significantly shorter in the case group than the control group [median (interquartile range), 23 days (8-41) vs. 32 days (15-54), P = 0.017]. In multivariate analyses, the type of antibiotic used was not an independent risk factor for treatment failure. The statistically significant factors associated with treatment failure included underlying hepatic diseases, prior receipt of antibiotics, and foreign body retention.
  
  
  CONCLUSIONS
  This study indicates that oral antibiotic therapy with active agents against MRSA isolates can be considered as the initial or step-down therapy for the treatment of MRSA infections and also reduce the length of hospital stay.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Yoon
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Eu Suk
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.
authors.forename: Jian
authors.initials: J
authors.lastname: Hur
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea.
authors.forename: Shinwon
authors.initials: S
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Shin Woo
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Medical Center, Seoul, Korea.
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Cheong
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea.
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Choo
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Hong Bin
authors.initials: HB
authors.lastname: Kim
keywords: Administration; Length of stay; Methicillin-resistant Staphylococcus aureus; Oral