Nathwani Dilip
Ninewells Hospital, Tayside University Hospitals, Dundee DD1 9SY, UK.
J Antimicrob Chemother. 2003 May;51 Suppl 2:ii37-44. doi: 10.1093/jac/dkg250.
The clinical and economic impact of methicillin-resistant staphylococcal infections on the patient, the hospital and the community is significant and continues to increase. Methicillin-resistant Staphylococcus aureus infections, in particular, represent a substantial burden of resistant infections in the hospital. As such, it is important to analyse the cost parameters associated with an episode of infection. Key determinants of the total cost of an episode of infection include fixed costs and hotel costs; the contribution of antimicrobial therapy, including drug acquisition and delivery costs, is comparatively marginal. Therefore, decreasing the hospital length of stay by promoting earlier hospital discharge will significantly reduce overall costs and, in effect, increase the efficiency and cost-effectiveness of the hospital. Linezolid, the first marketed agent of a new class of oxazolidinone antibiotics, is effective in the treatment of serious Gram-positive infections. Its availability in both intravenous (iv) and oral formulations (the latter of which is 100% bioavailable) facilitates early discharge from hospital. Hospitalized patients with methicillin-resistant staphylococcal infections who were treated with either linezolid or vancomycin demonstrated no significant differences in clinical outcome or mortality. However, compared with vancomycin, administration of linezolid reduced the duration of iv therapy and increased the chance of being discharged during the first week of hospitalization. These effects were most pronounced in the subset of patients with skin and soft tissue infections. Knowledge of these data may influence prescribing practices at the individual and organizational levels and, in turn, reduce the economic burden associated with MRSS infections.
耐甲氧西林葡萄球菌感染对患者、医院和社区造成的临床和经济影响重大，且仍在不断增加。特别是耐甲氧西林金黄色葡萄球菌感染，在医院耐药感染中占相当大的比重。因此，分析与感染发作相关的成本参数很重要。感染发作总成本的关键决定因素包括固定成本和住院费用；抗菌治疗的贡献，包括药品采购和配送成本，相对较小。因此，通过促进提前出院来缩短住院时间将显著降低总体成本，实际上还能提高医院的效率和成本效益。利奈唑胺是新型恶唑烷酮类抗生素中首个上市的药物，对治疗严重革兰氏阳性菌感染有效。其静脉注射（iv）和口服制剂（后者生物利用度为100%）均有供应，便于患者早日出院。接受利奈唑胺或万古霉素治疗的耐甲氧西林葡萄球菌感染住院患者，在临床结局或死亡率方面无显著差异。然而，与万古霉素相比，使用利奈唑胺可缩短静脉治疗时间，并增加住院第一周内出院的机会。这些效果在皮肤和软组织感染患者亚组中最为明显。了解这些数据可能会影响个人和组织层面的处方行为，进而减轻与耐甲氧西林葡萄球菌感染相关的经济负担。
