title: Comparative-effectiveness of vancomycin and linezolid as part of guideline-recommended empiric therapy for healthcare-associated pneumonia.
abstract: BACKGROUND
  Linezolid has been directly compared to vancomycin in pneumonia; however, most clinical trials have not compared outcomes specifically in the healthcare-associated pneumonia (HCAP) population. The objective of this study was to compare the effectiveness of vancomycin and linezolid in a national cohort of hospitalized veterans with HCAP.
  
  
  METHODS
  This was a retrospective cohort study of Veterans Health Administration patients admitted to >150 hospitals across the United States between 2002 and 2007. Patients were included if they were at least 65 years old, had an ICD-9-CM code for pneumonia, had one or more HCAP risk factors, and received guideline-concordant antibiotic therapy with linezolid or vancomycin within 48 h of admission. Critically ill patients were excluded. Multivariable logistic regression models and propensity scores were used to examine the association between linezolid or vancomycin therapy and 30-day mortality.
  
  
  RESULTS
  A total of 1211 patients met study criteria; 946 received vancomycin and 265 received linezolid. Thirty-day mortality was higher in patients treated with vancomycin (n = 243; 25.7 %) as compared to linezolid (n = 33; 12.5 %) (adjusted OR 2.56; 95 % CI 1.67-4.04). Vancomycin use (n = 945) was also predictive of 30-day mortality compared to linezolid use (n = 264) in the propensity score analysis (adjusted OR 2.55; 95 % CI 1.66-4.02).
  
  
  CONCLUSIONS
  Linezolid was associated with decreased patient mortality compared to vancomycin in a national cohort of non-critically ill, hospitalized veterans with HCAP.
authors.affiliation: College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA. kdaniels46@utexas.edu.|Pharmacotherapy Education and Research Center (PERC), School of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., MSC-6220, San Antonio, TX, 78229-3900, USA. kdaniels46@utexas.edu.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Reveles
authors.affiliation: The VA North Texas Health Care System, Dallas, TX, USA. eric.mortensen@utsouthwestern.edu.|School of Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines, Boulevard, Dallas, TX, USA. eric.mortensen@utsouthwestern.edu.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mortensen
authors.affiliation: Feik School of Pharmacy, University of the Incarnate Word, 4301 Broadway, CPO #99, San Antonio, TX, USA. attridge@uiwtx.edu.
authors.forename: Russell T
authors.initials: RT
authors.lastname: Attridge
authors.affiliation: College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA. freic@uthscsa.edu.|Pharmacotherapy Education and Research Center (PERC), School of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., MSC-6220, San Antonio, TX, 78229-3900, USA. freic@uthscsa.edu.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Frei
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D000069349:Linezolid / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000069349:Linezolid