Medical Service, VA Puget Sound Health Care System, 1880 S. Columbian Way (S-111-GIMC), Seattle, WA 98108-1587, USA.
Int J Infect Dis. 2011 Feb;15(2):e140-6. doi: 10.1016/j.ijid.2010.10.003. Epub 2010 Dec 4.
To compare outcomes of treating complicated skin and skin structure infections (cSSSI) caused by methicillin-resistant Staphylococcus aureus (MRSA) with linezolid versus vancomycin in diabetic and non-diabetic patients.
We pooled data from three prospective clinical trials in which 1056 patients were randomized to receive either linezolid (intravenous (IV) or oral) or vancomycin (IV) every 12h, for 7-28 days.
Diabetic (n=349) and non-diabetic patients (n=707) had comparable demographics and co-morbidities. Clinical success rates were lower in diabetic than in non-diabetic patients (72.3% and 85.8%, respectively). Overall, non-diabetic patients had a shorter adjusted mean length of stay (LOS) compared with diabetic patients (8.2 and 10.7 days, respectively; p<0.0001). Among diabetic patients, rates were comparable with linezolid and vancomycin treatment for clinical success (74% and 71%, respectively) and microbiological success (60% and 54%, respectively). Among non-diabetic patients, clinical and microbiological success rates were higher in linezolid- than in vancomycin-treated patients (90% and 81%, respectively, and 78% and 65%, respectively). Rates of drug-related adverse events were comparable in diabetic and non-diabetic patients and with linezolid and vancomycin treatment. Adjusted mean LOS was shorter with linezolid than with vancomycin treatment in diabetic patients (9.5 and 11.7 days, respectively; p=0.03) and non-diabetic patients (7.6 and 8.9 days, respectively; p=0.02).
Clinical success rates were lower in diabetic than non-diabetic patients with cSSSI caused by MRSA. Comparing linezolid and vancomycin, clinical and microbiological success rates were comparable in diabetic patients, but were better for linezolid than for vancomycin in non-diabetic patients.
比较治疗耐甲氧西林金黄色葡萄球菌（MRSA）引起的复杂性皮肤和皮肤结构感染（cSSSI）时，利奈唑胺与万古霉素在糖尿病和非糖尿病患者中的疗效。
我们汇总了三项前瞻性临床试验的数据，其中 1056 名患者被随机分为利奈唑胺（静脉或口服）或万古霉素（每 12 小时静脉给药）组，治疗 7-28 天。
糖尿病（n=349）和非糖尿病患者（n=707）的人口统计学特征和合并症相似。糖尿病患者的临床治愈率低于非糖尿病患者（分别为 72.3%和 85.8%）。总体而言，非糖尿病患者的调整平均住院时间（LOS）短于糖尿病患者（分别为 8.2 和 10.7 天；p<0.0001）。在糖尿病患者中，利奈唑胺与万古霉素治疗的临床治愈率（分别为 74%和 71%）和微生物学治愈率（分别为 60%和 54%）相当。在非糖尿病患者中，利奈唑胺治疗的临床和微生物学治愈率高于万古霉素治疗（分别为 90%和 81%，78%和 65%）。糖尿病和非糖尿病患者中药物相关不良事件的发生率与利奈唑胺和万古霉素治疗相似。糖尿病患者中，利奈唑胺治疗的调整平均 LOS 短于万古霉素治疗（分别为 9.5 和 11.7 天；p=0.03），非糖尿病患者中，利奈唑胺治疗的调整平均 LOS 短于万古霉素治疗（分别为 7.6 和 8.9 天；p=0.02）。
MRSA 引起的 cSSSI 患者中，糖尿病患者的临床治愈率低于非糖尿病患者。与万古霉素相比，利奈唑胺治疗糖尿病患者的临床和微生物学治愈率相当，但在非糖尿病患者中，利奈唑胺的效果优于万古霉素。
