Comparison of Methicillin-ResistantStaphylococcus aureusCommunity-Acquired and Healthcare-Associated Pneumonia
Ah Young LeemWon Jai JungYoung Ae KangSeon Cheol ParkYoung Jae KimEu Dong HwangEun Young KimKyung Soo JungMoo Suk ParkSong Yee KimYoung Sam KimSoon Il KimJoon ChangJi Ye Jung
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Purpose: Methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an important cause of not only healthcare-associated pneumonia (HCAP) but also community-acquired pneumonia (CAP).We determined the impact of MRSA on differences in clinical characteristics, courses, and outcomes between CAP and HCAP.Materials and Methods: We conducted a retrospective observational study on 78 adult patients admitted with MRSA pneumonia at a university-affiliated tertiary hospital between January 2008 and December 2011.We compared baseline characteristics, chest radiographs, treatment outcomes, and drug resistance patterns between the CAP and HCAP groups.Results: Of the 78 patients with MRSA pneumonia, 57 (73.1%) were HCAP and 21 (26.9%) were CAP.MRSA infection history in the previous year (29.8% vs. 14.3%, p=0.244) tended to be more common in HCAP than in CAP.Despite similar Pneumonia Severity Index scores (151 in CAP vs. 142 in HCAP), intubation rates (38.1% vs. 17.5%;p=0.072) and intensive care unit admission (42.9% vs. 22.8%; p=0.095) tended to be higher in the CAP group, while 28-day mortality was higher in the HCAP group (14.3% vs. 26.3%;p=0.368), although without statistical significance.All patients showed sensitivity to vancomycin and linezolid; meanwhile, HCAP patients showed greater resistance to gentamicin than CAP patients (58.3% vs. 16.6%;p=0.037).The median total hospital charges were 6899 American dollars for CAP and 5715 American dollars for HCAP (p=0.161).Conclusion: MRSA pneumonia showed significantly differences in baseline characteristics, chest radiographs, treatment outcomes, and medical expenses between HCAP and CAP groups.Keywords:
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Pneumonia severity index
Post-antibiotic effect of linezolid and vancomycin against methicillin-resistant Staphyloccus aureus
Objective To investigate the post-antibiotic effect(PAE) of linezolid and vancomycin against methicillin-resistant Staphyloccus aureus(MRSA).Methods PAE of linezolid and vancomycin against MRSA was determined by plate colony counting at different concentrations(1×MIC,2×MIC,4×MIC,8×MIC) and different time points(1,2,3 h).The morphological changes of MRSA during the PAE period were observed by scanning electron microscopy.Results All strains were susceptible to linezolid and vancomycin.The PAE was greater at higher concentration and longer exposure time.There was no morphological change of MRSA during the PAE.Conclusion It was demonstrated that linezolid and vacomycin had a moderate in vitro PAE against MRSA.There was no morphological change of MRSA during the PAE.
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OBJECTIVE: To analyze the effectiveness of linezolid vs.vancomycin in the treatment of retention catheterization infection induced by methicillin-resistant staphylococcus aureus(MRSA) infections.METHODS: 53 patients with MRSA infection treated divided into linezolid group(27 cases) and vancomycin group(26 cases).Linezolid group was given linezolid 600 mg every 12 hours,and vancomycin group was given vancomycin 1 g every 12 hours.After 14 days treatment,microbiologic eradications of 2 groups of drugs were analyzed.RESULTS: After 14 days treatment,the cure rates of linezolid group and vancomycin group were 66.7% and 23.1%.There was statistical significance(P0.05).CONCLUSION: The effectiveness of linezolid are similar to those of vancomycin in the treatment of gram-positive bacterial infection,but the cure rate of linezolid is higher than vancomycin in 14 days.
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The present study was designed to compare in vitro antibacterial activities of linezolid and vancomycin against vancomycin-susceptible Enterococcus faecalis (VSEF) and vancomycin-resistant enterococci (VRE) isolated in Japan with those of quinupristin–dalfopristin, teicoplanin and minocycline, and the in vitro short time bactericidal activity and the in vivo activities of linezolid and vancomycin against vancomycin-susceptible and -resistant E. faecalis. The MIC90s of linezolid, quinupristin–dalfopristin, vancomycin, teicoplanin and minocycline for VSEF and VRE were both 2 mg/L, both 2 mg/L, 2 and >128 mg/L, 0.25 and >128 mg/L, and both 32 mg/L, respectively. The efficacy of linezolid for mice with bacteraemia caused by VSEF was similar to that of vancomycin, but the elimination ratio of viable organisms from the blood of mice treated with vancomycin was significantly higher than in linezolid-treated and untreated mice at 2 h post-administration, and those of the two groups at 4 and 6 h were significantly higher than in untreated mice. Moreover, linezolid was highly active in mice with bacteraemia caused by vancomycin-resistant E. faecalisbecause this drug had potent in vitro activity against the organisms. Our results indicate that linezolid is suitable for the treatment of VRE and VSEF bacteraemia, and vancomycin is suitable for VSEF bacteraemia.
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Objective : We investigated experimentally the in vivo prophylactic efficacies of linezolid, teicoplanin and vancomycin in subcutaneously implanted dacron graft infection caused by methicillin-resistant Staphylococcus aureus (MRSA).
Materials and methods : Dacron grafts (1 cm2) were aseptically implanted into subcutaneous pockets that were surgically prepared in the backs of 50 rats. Ten of these rats were used as the control group (group I). Grafts in the remaining 40 rats were infected by inoculation of MRSA at the concentration of 2 x 107 colony-forming units (CFU) / ml. Ten of these rats constituted the contaminated, untreated group II. The other three study groups comprising 10 rats each were contaminated and then treated with linezolid (group III), teicoplanin (group IV) and vancomycin (group V), respectively. All rats were sacrificed and the grafts were removed after seven days and evaluated.
Results : The bacterial count decreased in the rats from the groups treated with linezolid, teicoplanin and vancomycin. The linezolid and teicoplanin groups, however, showed a significantly lower bacterial number than the vancomycin group (p = 0.009 and p = 0.01). The intensity of inflammation was highest in the contaminated, untreated group, as expected.
Conclusions : Single-dose linezolid, teicoplanin and vancomycin for peri-operative prophylaxis may prevent bacterial growth in vascular graft infections. The effect of linezolid and teicoplanin seemed similar and their effect was greater than that of vancomycin.
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Methicillin resistant Staphylococcus aureus (MRSA) has emerged as one of the commonest cause of hospital acquired infections worldwide. Vancomycin is the antibiotic of choice for treatment of MRSA, but due to slow increase in vancomycin minimum inhibitory concentration (MIC) (vancomycin creep),Vancomycin has become a suboptimal therapeutic option in critically ill patients. Linezolid has emerged as an alternative drug in the treatment of such cases.
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The levels of effectiveness of linezolid, vancomycin, and the combination of linezolid and vancomycin were compared in the rabbit model of endocarditis caused by a clinical methicillin-resistant Staphylococcus aureus (MRSA) isolate. Vancomycin alone was more effective than either linezolid alone or the combination of linezolid and vancomycin for the treatment of endocarditis due to MRSA.
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Vancomycin is the mainstay of treatment for methicillin-resistant Staphylococcus aureus (MRSA) meningitis. However, successful outcomes with linezolid have not been reported in a large series of patients. We conducted a single-center retrospective cohort study to compare vancomycin with linezolid in the treatment of MRSA meningitis.We extracted data and outcomes for all adult patients (age >18 years) with culture-proved MRSA meningitis who received vancomycin or linezolid between January 2006 and June 2011. A definite diagnosis of meningitis was based on the isolation of MRSA in at least one cerebrospinal fluid (CSF) culture and findings in CSF that are typical of the infection. Linezolid was given intravenously (IV) at a dosage of 600 mg q12h and vancomycin IV at 500 mg q6h.A total of 8 patients with MRSA meningitis (5 male, 3 female; age [mean±SD] 61.6±13.2 years) received vancomycin and 9 patients (7 male, 2 female; age 59.1±15.6 years) received linezolid. All isolated strains of MRSA were susceptible to both vancomycin and linezolid. The rates of microbiologic success with linezolid or vancomycin, in terms of clearance of MRSA from CSF on day 5, were 7/9 and 2/8 (p=0.044, Fisher exact test). No severe adverse events occurred in either treatment arm of the study. One-month survival of the patients in whom treatment was successful microbiologically was 2/2 in the vancomycin-treated group and 4/7 in the linezolid-treated group. Minimum inhibitory concentration (MIC) data for vancomycin were available for 5/6 treatment failures with vancomycin, and vancomycin MIC values of these five strains were 2 mg/L.Analysis of the findings in the limited cohorts in our study suggests that linezolid is superior to vancomycin for treating MRSA meningitis, especially in cases in which there is a high MIC (2 mg/L) for vancomycin. A clinical study involving larger cohorts may increase the evidence available in relation to this question.
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[Objective]The paper aims to explore the difference of vancomycin,teicoplanin and linezolid in the inducing resistance of MRSA by measuring MIC before and after drug inducing.[Methods]The MIC of Nine MRSA to vancomycin,teicoplanin and linezolid are identified by two-fold agar dilution method,and then two MRSA which are sensitive to the three drugs are found out.The two MRSA are induced separately by vancomycin,teicoplanin and linezolid for 25 generations.At last,the MIC of MRSA which have been induced to vancomycin,teicoplanin and linezolid are identified.The data is analyzed by SPSS 19.0.[Results]After vancomycin,teicoplanin and linezolid inducing MRSA for 25 generations respectively,the MIC of vancomycin and linezolid increased 2 times and teicoplanin increased 2.67 times compared with those before drug induction.However,there was no difference of the change of MIC among the 3 groups.Additionally,no resistant strains were generated.The MIC of 3 drugs to MRSA strains in control groups in drug-free plates did not change after passage.[Conclusions]The comparison of the three drugs at inducing resistance have no significant difference.
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Endocarditis, and prosthetic valve endocarditis in particular, is a serious disease with high morbidity and mortality. We investigate the effects of tigecycline, linezolid and vancomycin on biofilms of viridans group streptococci (VGS) isolated from patients with definite native or prosthetic valve endocarditis.Ten of 20 VGS blood stream isolates from patients with endocarditis formed biofilms in the microtiter plate biofilm model. The minimal inhibitory concentrations (MIC) for tigecycline, linezolid and vancomycin were determined using the microdilution broth method. Biofilms were grown for 24 hours and were incubated with tigecycline, linezolid and vancomycin at increasing concentrations from 1-128x MIC of the isolate being tested. Biofilm thickness was quantified by measuring the optical density (OD) after dyeing it with crystal violet. The incubation of the biofilms with tigecycline, linezolid or vancomycin resulted in a significant reduction of OD compared to the control biofilm without antibiotic (p<0.05). The optical density ratio (Odr) decreased significantly at 2x MIC for tigecycline, and at 8x MIC for linezolid and vancomycin (p<0.05). Although biofilms persisted even at the highest antibiotic concentrations of 128x MIC, bacterial growth was eradicated starting at concentrations of 16x MIC for vancomycin and of 32x MIC for linezolid, but not for tigecycline, up to a concentration of 128x MIC.In the present study on viridans streptococci isolated from patients with endocarditis, tigecycline and linezolid reduced the density of the biofilms as effectively as vancomycin. However, linezolid and vancomycin were bactericidal at higher concentrations. Linezolid and vancomycin at very high doses may be useful in the treatment of biofilm-associated diseases caused by VGS infections.
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Vancomycin serum levels (VSL) were measured to prevent dose-dependent side effects. However, the cost of VSL is high, therefore in some cases alternative antibacterial treatments, such as linezolid, can be used. The aim of this study was to perform an economic analysis of the cost of linezolid compared to vancomycin plus therapeutic drug monitoring. This is an ecological, retrospective, quantitative study, conducted in a Brazilian public university hospital. The study period was from January 2018 to January 2019. First part from January/18 - July/18 based on pre-linezolid data (T1) and another after the introduction of linezolid from August/18 - January/19 (T2). A breakeven analysis to vancomycin substitution was performed following 3 scenarios: (i) in all patients, (ii) in critically ill patients with renal failure or (iii) only in patients in hemodialysis. The DDD/1000-patients day, MRSA incidence, costs with VSL, as well as the costs of drugs (vancomycin and linezolid) and infusion kits were evaluated. Vancomycin was substituted in critically ill patients with renal failure from T1 to T2. The incidence of MRSA infections did not vary between T1 and T2. Vancomycin consume maintained constant (p=0.157); while linezolid consuming increased (0 DDD/1000PD versus 33.4 DDD/1000PD; p=0.002). Vancomycin and linezolid costs was lower in T1 than T2 (USD 9202,00 versus 11331,00; p=0.015). Linezolid implementation as a strategy to avoid vancomycin plus VSL was not cost-effective in critically ill patients with renal failure. More studies are needed to understand if linezolid implementation may be cost-effective in different scenarios.
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