Yoon Young Kyung, Kim Eu Suk, Hur Jian, Lee Shinwon, Kim Shin Woo, Cheong Jin Won, Choo Eun Ju, Kim Hong Bin
Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Infect Chemother. 2014 Sep;46(3):172-81. doi: 10.3947/ic.2014.46.3.172. Epub 2014 Sep 24.
Carefully switching from intravenous to oral antibiotic therapy has shown to reduce treatment costs and lengths of hospital stay as well as increase safety and comfort in patients with infections. The aim of this study was to compare the clinical efficacy and safety between the patients treated with glycopeptides (case group), and the patients given oral antibiotics, as the initial or step-down therapy (control group), in the treatment of patients with methicillin-resistant Staphylococcus aureus (MRSA) infection.
A multicenter observational study was retrospectively performed in 7 teaching hospitals in Korea from January to December 2012. The study included adult patients (≥ 18 years) with infection caused by MRSA isolates, susceptible to clindamycin, erythromycin, and ciprofloxacin. The primary end point was treatment outcome, including all-cause mortality and switching of antibiotics. Drug-related adverse events and the lengths of hospital stay were also compared between the two treatment groups.
During the study period, 107 patients (43 cases and 64 controls) with MRSA infections were enrolled from the participating hospitals. The most common sites of MRSA infection were skin and soft tissue (n = 28) and bone and joint (n = 26). The median Charlson comorbidity index (P = 0. 560), the frequency of severe sepsis (P = 0.682) or thrombocytopenia (P = 1.000), and median level of serum C-reactive protein (P = 0.157) at the onset of MRSA infections were not significantly different between the case and control groups. The oral antibiotics most frequently prescribed in the case group, were fluoroquinolones (n = 29) and clindamycin (n = 8). The median duration of antibiotic treatment (P = 0.090) and the occurrence of drug-related adverse events (P = 0.460) did not reach statistically significant difference between the two groups, whereas the total length of hospital stay after the onset of MRSA infection was significantly shorter in the case group than the control group [median (interquartile range), 23 days (8-41) vs. 32 days (15-54), P = 0.017]. In multivariate analyses, the type of antibiotic used was not an independent risk factor for treatment failure. The statistically significant factors associated with treatment failure included underlying hepatic diseases, prior receipt of antibiotics, and foreign body retention.
This study indicates that oral antibiotic therapy with active agents against MRSA isolates can be considered as the initial or step-down therapy for the treatment of MRSA infections and also reduce the length of hospital stay.
谨慎地从静脉抗生素治疗转换为口服抗生素治疗已被证明可降低治疗成本、缩短住院时间，并提高感染患者的安全性和舒适度。本研究的目的是比较用糖肽类药物治疗的患者（病例组）与接受口服抗生素作为初始或降阶梯治疗的患者（对照组）在治疗耐甲氧西林金黄色葡萄球菌（MRSA）感染时的临床疗效和安全性。
2012年1月至12月在韩国7家教学医院进行了一项多中心观察性研究。该研究纳入了年龄≥18岁、由对克林霉素、红霉素和环丙沙星敏感的MRSA分离株引起感染的成年患者。主要终点是治疗结果，包括全因死亡率和抗生素更换情况。还比较了两个治疗组的药物相关不良事件和住院时间。
在研究期间，从参与研究的医院招募了107例MRSA感染患者（43例病例组和64例对照组）。MRSA感染最常见的部位是皮肤和软组织（n = 28）以及骨和关节（n = 26）。病例组和对照组在MRSA感染发作时的中位Charlson合并症指数（P = 0.560）、严重脓毒症发生率（P = 0.682）或血小板减少症发生率（P = 1.000）以及血清C反应蛋白中位水平（P = 0.157）无显著差异。病例组最常开具的口服抗生素是氟喹诺酮类（n = 29）和克林霉素（n = 8）。两组之间抗生素治疗的中位持续时间（P = 0.090）和药物相关不良事件的发生率（P = 0.460）未达到统计学显著差异，而MRSA感染发作后病例组的总住院时间明显短于对照组[中位数（四分位间距），23天（8 - 41）对32天（15 - 54），P = 0.017]。在多变量分析中，所用抗生素类型不是治疗失败的独立危险因素。与治疗失败相关的具有统计学意义的因素包括潜在肝病、先前接受过抗生素治疗以及异物存留。
本研究表明，针对MRSA分离株使用活性药物进行口服抗生素治疗可被视为治疗MRSA感染的初始或降阶梯治疗方法，并且还可缩短住院时间。
