Salvage Treatment for Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia: Efficacy of Linezolid With or Without Carbapenem

Clinical Infectious Diseases, Aug 2009

Background. Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with high mortality rates, but no treatment strategy has yet been established. We performed this study to evaluate the efficacy of linezolid with or without carbapenem in salvage treatment for persistent MRSA bacteremia. Methods. All adult patients with persistent MRSA bacteremia for ⩾7 days from January 2006 through March 2008 who were treated at Seoul National University Hospital were studied. The results of linezolid salvage therapy with or without carbapenem were compared with those of salvage therapy with vancomycin plus aminoglycosides or rifampicin. Results. Thirty-five patients with persistent MRSA bacteremia were studied. The early microbiological response (ie, negative results for follow-up blood culture within 72 hours) was significantly higher in the linezolid-based salvage therapy group than the comparison group (75% vs 17%; P=.006). Adding aminoglycosides or rifampicin to vancomycin was not successful in treating any of the patients, whereas linezolid-based therapy gave an 88% salvage success rate (P<.001). The S. aureus -related mortality rate was lower for patients treated with a linezolid salvage regimen than for patients continually treated with a vancomycin-based regimen (13% vs 53%; P=.030). Conclusions. Linezolid-based salvage therapy effectively eradicated S. aureus from the blood for patients with persistent MRSA bacteremia. The salvage success rate was higher for linezolid therapy than for vancomycin-based combination therapy.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://cid.oxfordjournals.org/content/49/3/395.full.pdf

Salvage Treatment for Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia: Efficacy of Linezolid With or Without Carbapenem

Hee-Chang Jang 0 1 Sung-Han Kim 0 1 3 Kye Hyoung Kim 0 1 Choong Jong Kim 0 1 Shinwon Lee 0 1 Kyoung-Ho Song 0 1 Jae Hyun Jeon 0 1 Wan Beom Park 0 1 Hong Bin Kim 0 1 Sang-Won Park 0 1 Nam Joong Kim 0 1 Eui-Chong Kim 0 1 2 Myoung-don Oh 0 1 Kang Won Choe 0 1 0 Received 21 October 2008; accepted 18 March 2009; electronically published 1 July 2009. Presented in part: 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/Infectious Diseases Society of America 46th Annual Meeting , Washington, DC, 25-28 October 2008 (abstract K-3485) 1 teremia. However , treatment failure in MRSA infections 2 Laboratory Medicine, Seoul National University College of Medicine , Seoul , Republic of Korea 3 Present affiliation: Department of Internal Medicine, University of Ulsan College of Medicine , Seoul , Republic of Korea. Seoul National University College of Medicine , 28 Yongun-dong, Chongro-gu, Seoul, 110-744 , Republic of Korea Background. Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with high mortality rates, but no treatment strategy has yet been established. We performed this study to evaluate the efficacy of linezolid with or without carbapenem in salvage treatment for persistent MRSA bacteremia. Methods. All adult patients with persistent MRSA bacteremia for 7 days from January 2006 through March 2008 who were treated at Seoul National University Hospital were studied. The results of linezolid salvage therapy with or without carbapenem were compared with those of salvage therapy with vancomycin plus aminoglycosides or rifampicin. Results. Thirty-five patients with persistent MRSA bacteremia were studied. The early microbiological response (ie, negative results for follow-up blood culture within 72 hours) was significantly higher in the linezolid-based salvage therapy group than the comparison group (75% vs 17%; P p .006). Adding aminoglycosides or rifampicin to vancomycin was not successful in treating any of the patients, whereas linezolid-based therapy gave an 88% salvage success rate (P ! .001). The S. aureus-related mortality rate was lower for patients treated with a linezolid salvage regimen than for patients continually treated with a vancomycin-based regimen (13% vs 53%; P p .030). Conclusions. Linezolid-based salvage therapy effectively eradicated S. aureus from the blood for patients with persistent MRSA bacteremia. The salvage success rate was higher for linezolid therapy than for vancomycin-based combination therapy. Staphylococcus aureus is a major cause of communityacquired and nosocomial infections [1]. The organism is the second most common cause of nosocomial bacteremia in the United States [2]. Glycopeptides have been used as the main treatment for serious methicillinresistant S. aureus (MRSA) infections, including bacLinezolid for Persistent MRSA Bacteremia CID 2009:49 (1 August) 395 - RESULTS Bacteremia Salvage method Linezolid No. of attempts Early microbiological response,a no. (%) of patients Salvage success,b no. (%) of patients Bacteremia Patient group Vancomycin Linezolid No. of patients S. aureusrelated mortality,a no. (%) of patients 30-day mortality,b no. (%) of patients DISCUSSION Acknowledgments Potential conflicts of interest. All authors: no conflicts.


This is a preview of a remote PDF: http://cid.oxfordjournals.org/content/49/3/395.full.pdf

Hee-Chang Jang, Sung-Han Kim, Kye Hyoung Kim, Choong Jong Kim, Shinwon Lee, Kyoung-Ho Song, Jae Hyun Jeon, Wan Beom Park, Hong Bin Kim, Sang-Won Park, Nam Joong Kim, Eui-Chong Kim, Myoung-don Oh, Kang Won Choe. Salvage Treatment for Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia: Efficacy of Linezolid With or Without Carbapenem, Clinical Infectious Diseases, 2009, 395-401, DOI: 10.1086/600295