McCollum Marianne, Sorensen Sonja V, Liu Larry Z
University o f Colorado at Denver and Health Sciences Center, Denver, Colorado 80262, USA.
Clin Ther. 2007 Mar;29(3):469-77. doi: 10.1016/s0149-2918(07)80085-3.
This study compared the costs and hospital length of stay (LOS) and duration of intravenous therapy associated with intravenous/oral linezolid or intravenous vancomycin treatment of complicated skin and soft-tissue infections (cSSTIs) caused by suspected or confirmed methicillin-resistant Staphylococcus aureus (MRSA) in elderly US patients.
Data were obtained from elderly (>or=65 years) US patients participating in a multinational randomized trial of hospitalized cSSTI patients treated with linezolid or vancomycin. Costs (hospital and total) from the provider perspective were estimated for intent-to-treat (ITT) patients (ie, all those receiving >or=1 dose) using national 2003 costs (ward, medication, intravenous administration). LOS for inpatient care, duration of intravenous linezolid and vancomycin therapy (ITT and MRSA groups), and cure rates were evaluated.
Of 717 enrolled subjects, 163 (23%) were elderly (87 linezolid, 76 vancomycin), with no significant differences in demographic characteristics between the linezolid and vancomycin groups. Mean hospitalization and total costs were lower with linezolid compared with vancomycin (hospitalization: US $4510 vs US $6478, P<0.001; total: US $6009 vs US $7329, P=0.03). Linezolid was associated with a 3.5-day reduction in LOS and a 9.5-day reduction in the duration of intravenous therapy compared with vancomycin in the ITT group (both, P<0.001). Cure rates were comparable between linezolid and vancomycin in both the ITT group (88.7% vs 81.4%, respectively) and the MRSA group (80.0% vs 71.4%). In multivariate analyses of the ITT group, linezolid patients were 57% less likely than vancomycin patients to have a LOS >7 days (odds ratio = 0.43; 95% CI, 0.21-0.87). Chronic renal failure, malnutrition, and a diagnosis of infected ulcer predicted an LOS >7 days.
In this analysis of data from elderly patients with cSSTI caused by suspected or confirmed MRSA, linezolid treatment was associated with reductions in the costs of care, LOS, and duration of intravenous treatment without affecting the clinical outcomes. Although the use of a subset of patients from a larger trial that did not focus on the elderly can be seen as a study limitation, the elderly represent an important population when evaluating health care resource use and costs.
本研究比较了美国老年患者静脉注射/口服利奈唑胺或静脉注射万古霉素治疗疑似或确诊耐甲氧西林金黄色葡萄球菌（MRSA）引起的复杂性皮肤和软组织感染（cSSTIs）的成本、住院时间（LOS）及静脉治疗持续时间。
数据来自参与利奈唑胺或万古霉素治疗住院cSSTI患者的多国随机试验的美国老年（≥65岁）患者。从提供者角度，使用2003年全国成本（病房、药物、静脉给药）对意向性治疗（ITT）患者（即所有接受≥1剂治疗的患者）的成本（医院成本和总成本）进行估算。评估住院护理的LOS、静脉注射利奈唑胺和万古霉素治疗的持续时间（ITT组和MRSA组）以及治愈率。
在717名登记受试者中，163名（23%）为老年人（87名利奈唑胺组，76名万古霉素组），利奈唑胺组和万古霉素组在人口统计学特征上无显著差异。与万古霉素相比，利奈唑胺的平均住院费用和总成本更低（住院费用：4510美元对6478美元，P<0.001；总成本：6009美元对7329美元，P=0.03）。在ITT组中，与万古霉素相比，利奈唑胺使LOS缩短3.5天，静脉治疗持续时间缩短9.5天（均P<0.001）。ITT组和MRSA组中利奈唑胺和万古霉素的治愈率相当（分别为88.7%对81.4%）。在ITT组的多变量分析中，利奈唑胺组患者LOS>7天的可能性比万古霉素组患者低57%（优势比=0.43；95%CI，0.21 - 0.87）。慢性肾衰竭、营养不良和感染性溃疡诊断预示LOS>7天。
在对疑似或确诊MRSA引起的cSSTI老年患者的数据进行的本分析中，利奈唑胺治疗与护理成本、LOS及静脉治疗持续时间的降低相关，且不影响临床结果。尽管使用来自未聚焦于老年人的更大规模试验的部分患者可视为一项研究局限性，但在评估医疗保健资源使用和成本时，老年人是一个重要群体。
