Department of Pharmacy (JBU, NHV, CKF, THS), Methodist University Hospital, and University of Tennessee Health Science Center, Department of Medicine (KOC, MSG), Department of Clinical Pharmacy (JBU, NV, CKF, THS), Memphis, TN.
Am J Med Sci. 2015 Jan;349(1):36-41. doi: 10.1097/MAJ.0000000000000338.
Bloodstream infections are a leading cause of death in the United States. Methicillin-resistant Staphylococcus aureus (MRSA) encompasses >50% of all S aureus strains in infected hospitalized patients and increases mortality, length of stay and healthcare costs. The objective of this study was to evaluate the treatment of MRSA bacteremia with daptomycin, linezolid and vancomycin.
Patients with MRSA bacteremia between June 2008 and November 2010 were reviewed retrospectively. A microbiology laboratory report identified patients with ≥ 1 positive MRSA blood culture. Patients ≥ 18 years receiving daptomycin, linezolid or vancomycin for ≥ 7 consecutive days were included. Polymicrobial blood cultures and patients treated concomitantly with >1 anti-MRSA agent were excluded.
Of 122 patients included, 53 received daptomycin, 15 received linezolid and 54 received vancomycin. Clinical and microbiologic cure rates were similar between daptomycin, linezolid and vancomycin (58.5% versus 60% versus 61.1%; 93.6% versus 100% versus 90%, respectively). Thirteen patients (daptomycin 4/24 versus linezolid 1/9 versus vancomycin 8/49, P = 0.5960) had recurrence while 12 patients had re-infection (daptomycin 5/42 versus linezolid 0/9 versus vancomycin 7/49, P = 0.4755). Treatment failure occurred in 11 patients treated with daptomycin, 4 with linezolid and 9 with vancomycin (P = 0.662). Compared with daptomycin and vancomycin, linezolid-treated patients had higher mortality (P = 0.0186).
No difference in clinical or microbiologic cure rates was observed between groups. Daptomycin and vancomycin appear equally efficacious for MRSA bacteremia, whereas linezolid therapy was associated with higher mortality.
血流感染是美国的主要死亡原因。耐甲氧西林金黄色葡萄球菌（MRSA）占感染住院患者中所有金黄色葡萄球菌株的>50%，并增加死亡率、住院时间和医疗保健成本。本研究的目的是评估达托霉素、利奈唑胺和万古霉素治疗 MRSA 菌血症的效果。
回顾性分析 2008 年 6 月至 2010 年 11 月期间的 MRSA 菌血症患者。微生物学实验室报告确定了至少有 1 份阳性 MRSA 血培养的患者。纳入至少接受达托霉素、利奈唑胺或万古霉素治疗>7 天的≥18 岁患者。排除多微生物血培养和同时接受>1 种抗-MRSA 药物治疗的患者。
在 122 例患者中，53 例接受达托霉素治疗，15 例接受利奈唑胺治疗，54 例接受万古霉素治疗。达托霉素、利奈唑胺和万古霉素的临床和微生物学治愈率相似（58.5%比 60%比 61.1%；93.6%比 100%比 90%）。13 例（达托霉素 4/24 例比利奈唑胺 1/9 例比万古霉素 8/49 例，P=0.5960）患者复发，12 例患者再感染（达托霉素 5/42 例比利奈唑胺 0/9 例比万古霉素 7/49 例，P=0.4755）。达托霉素治疗的 11 例患者、利奈唑胺治疗的 4 例患者和万古霉素治疗的 9 例患者治疗失败（P=0.662）。与达托霉素和万古霉素相比，利奈唑胺治疗的患者死亡率更高（P=0.0186）。
各组之间的临床或微生物学治愈率无差异。达托霉素和万古霉素治疗 MRSA 菌血症的疗效似乎相当，而利奈唑胺治疗与更高的死亡率相关。
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