title: Trimethoprim/sulfamethoxazole versus vancomycin in the treatment of healthcare/ventilator-associated MRSA pneumonia: a case-control study.
abstract: Therapeutic options available to treat MRSA pneumonia are limited. Trimethoprim/sulfamethoxazole is an attractive treatment because of its bactericidal anti-MRSA activity, oral and parenteral formulations and good penetration to the lung tissue. We aimed to compare the efficacy and safety of trimethoprim/sulfamethoxazole with vancomycin in the treatment of healthcare/ventilator-associated MRSA pneumonia.
  
  
  
  We carried out a retrospective case-control study of all consecutive hospitalized adult patients diagnosed with MRSA pneumonia at Beilinson Hospital during 2010-15 and treated with either vancomycin or trimethoprim/sulfamethoxazole. The primary outcomes were all-cause mortality at 30 days and clinical failure at the end of treatment. In order to reduce bias affecting the decision to use a specific antibiotic and as a sensitivity analysis, a propensity-score model for choosing between vancomycin and trimethoprim/sulfamethoxazole was used.
  
  
  
  We identified 42 patients with MRSA pneumonia treated with trimethoprim/sulfamethoxazole and 39 treated with vancomycin. There were no significant differences in the baseline characteristics between the groups. Vancomycin-treated patients showed significantly higher 30 day mortality on both multivariate analysis (HR = 5.28; 95% CI = 1.50-18.60; P  < 0.05) and sensitivity analysis with propensity score [vancomycin 13/24 (54.1%) versus trimethoprim/sulfamethoxazole 4/24 (16.7%); P  < 0.05], and higher clinical failure rates [vancomycin 23/39 (59%) versus trimethoprim/sulfamethoxazole 15/42 (35.7%); P  < 0.05], also in the sensitivity analysis with propensity score [vancomycin 14/24 (58.3%) versus trimethoprim/sulfamethoxazole 6/24 (25%); P  < 0.05]. The rates of side effects in both arms were comparable.
  
  
  
  Trimethoprim/sulfamethoxazole appears to be superior to vancomycin in the treatment of MRSA pneumonia. A large-scale randomized controlled trial is needed to evaluate these findings.
authors.affiliation: Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.|Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Noa
authors.initials: N
authors.lastname: Eliakim-Raz
authors.affiliation: Department of Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Moran
authors.initials: M
authors.lastname: Hellerman
authors.affiliation: Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Dafna
authors.initials: D
authors.lastname: Yahav
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.|Intensive Care Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Department of Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Ili
authors.initials: I
authors.lastname: Margalit
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Fisher
authors.affiliation: Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Oren
authors.initials: O
authors.lastname: Zusman
authors.affiliation: Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Hila
authors.initials: H
authors.lastname: Shaked
authors.affiliation: Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Jihad
authors.initials: J
authors.lastname: Bishara
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy*; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination