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Methicillin-Resistant Staphylococcus aureus Nosocomial Pneumonia Nosocomial Pneumonia FREE TO VIEW

Visanu Thamlikitkul, MD; Sasima Tongsai, PhD
Author and Funding Information

From Siriraj Hospital.

Correspondence to: Visanu Thamlikitkul, MD, Siriraj Hospital, Bangkok, 10700, Thailand; e-mail: visanut@yahoo.com

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Thamlikitkul has received fees for being a speaker, researcher, or member of an advisory board from Janssen, Daiichi, Pfizer Inc, and Merck & Co, Inc. Dr Tongsai has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Thamlikitkul has received fees for being a speaker, researcher, or member of an advisory board from Janssen, Daiichi, Pfizer Inc, and Merck & Co, Inc. Dr Tongsai has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(1):269. doi:10.1378/chest.12-0582
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To the Editor:

With regard to the article by Walkey et al1 in CHEST (May 2011), we would like to inform you that there was an additional study presented at a late-breaking session at the 48th Annual Meeting of the Infectious Diseases Society of America in October 2010, and it was just published in a journal in March 2012.2 It was a randomized, double-blind, multicenter trial that compared the efficacy and safety of linezolid with that of vancomycin in adults who had nosocomial pneumonia due to culture-proven methicillin-resistant Staphylococcus aureus (MRSA).

A total of 1,184 subjects were randomized and received linezolid (600 mg every 12 h) or vancomycin (15 mg/kg every 12 h) for 7 to 14 days. The groups were comparable in terms of demographics and other clinical parameters. The patients with culture-proven MRSA pneumonia were those who had a quantitative culture of MRSA ≥104 colony-forming units/mL of BAL or ≥103 colony-forming units/mL of protected specimen brush sample. The clinical success rates in the subjects with proven MRSA pneumonia at the end of the study were 95 of 165 (57.6%) for the linezolid group and 81 of 174 (46.6%) for the vancomycin group.

If the aforementioned study is included in the meta-analysis, as shown in Figure 1,2-7 the relative risk of clinical success of the patients who received linezolid will become 1.23 (95% CI, 1.06-1.45; P = .009). Therefore, linezolid is statistically more effective than vancomycin for the treatment of proven MRSA nosocomial pneumonia. It should be kept in mind, however, that linezolid must be prescribed to patients with suspected MRSA nosocomial pneumonia, and only 30% to 40% of patients suspected of having MRSA pneumonia actually have proven MRSA pneumonia. Moreover, although the pooled estimate of a difference in efficacy of linezolid over vancomycin from our meta-analysis is 10.8%, the 95% CI of such a difference is 3.2% to 18.5%. Therefore, a cost-effectiveness analysis should be performed to determine if linezolid is efficient for empirical therapy of suspected MRSA nosocomial pneumonia and for specific therapy of proven MRSA nosocomial pneumonia.

Figure Jump LinkFigure 1.  Forest plot of clinical success in subjects with culture-positive MRSA pneumonia. MRSA = methicillin-resistant Staphylococcus aureus.2-7Grahic Jump Location
Walkey AJ, O’Donnell MR, Wiener RS. Linezolid vs glycopeptide antibiotics for the treatment of suspected methicillin-resistantStaphylococcus aureusnosocomial pneumonia: a meta-analysis of randomized controlled trials. Chest. 2011;139(5):1148-1155.. [PubMed] [CrossRef]
 
Wunderink RG, Niederman MS, Kollef MH, et al. Linezolid in methicillin-resistantStaphylococcus aureusnosocomial pneumonia: a randomized, controlled study. Clin Infect Dis. 2012;54(5):621-629.
 
Stevens DL, Herr D, Lampiris H, Hunt JL, Batts DH, Hafkin B. Linezolid versus vancomycin for the treatment of methicillin-resistantStaphylococcus aureusinfections. Clin Infect Dis. 2002;34(11):1481-1490.
 
Wunderink RG, Cammarata SK, Oliphant TH, Kollef MH. Linezolid Nosocomial Pneumonia Study Group. Continuation of a randomized, double-blind, multicenter study of linezolid versus vancomycin in the treatment of patients with nosocomial pneumonia. Clin Ther. 2003;25(3):980-992.
 
Cepeda JA, Whitehouse T, Cooper B, et al. Linezolid versus teicoplanin in the treatment of Gram-positive infections in the critically ill: a randomized, double-blind, multicentre study. J Antimicrob Chemother. 2004;53(2):345-355.
 
Kohno S, Yamaguchi K, Aikawa N, et al. Linezolid versus vancomycin for the treatment of infections caused by methicillin-resistantStaphylococcus aureusin Japan. J Antimicrob Chemother. 2007;60(6):1361-1369.
 
Wunderink RG, Mendelson MH, Somero MS, et al. Early microbiological response to linezolid vs vancomycin in ventilator-associated pneumonia due to methicillin-resistantStaphylococcus aureusChest. 2008;134(6):1200-1207.
 

Figures

Figure Jump LinkFigure 1.  Forest plot of clinical success in subjects with culture-positive MRSA pneumonia. MRSA = methicillin-resistant Staphylococcus aureus.2-7Grahic Jump Location

Tables

References

Walkey AJ, O’Donnell MR, Wiener RS. Linezolid vs glycopeptide antibiotics for the treatment of suspected methicillin-resistantStaphylococcus aureusnosocomial pneumonia: a meta-analysis of randomized controlled trials. Chest. 2011;139(5):1148-1155.. [PubMed] [CrossRef]
 
Wunderink RG, Niederman MS, Kollef MH, et al. Linezolid in methicillin-resistantStaphylococcus aureusnosocomial pneumonia: a randomized, controlled study. Clin Infect Dis. 2012;54(5):621-629.
 
Stevens DL, Herr D, Lampiris H, Hunt JL, Batts DH, Hafkin B. Linezolid versus vancomycin for the treatment of methicillin-resistantStaphylococcus aureusinfections. Clin Infect Dis. 2002;34(11):1481-1490.
 
Wunderink RG, Cammarata SK, Oliphant TH, Kollef MH. Linezolid Nosocomial Pneumonia Study Group. Continuation of a randomized, double-blind, multicenter study of linezolid versus vancomycin in the treatment of patients with nosocomial pneumonia. Clin Ther. 2003;25(3):980-992.
 
Cepeda JA, Whitehouse T, Cooper B, et al. Linezolid versus teicoplanin in the treatment of Gram-positive infections in the critically ill: a randomized, double-blind, multicentre study. J Antimicrob Chemother. 2004;53(2):345-355.
 
Kohno S, Yamaguchi K, Aikawa N, et al. Linezolid versus vancomycin for the treatment of infections caused by methicillin-resistantStaphylococcus aureusin Japan. J Antimicrob Chemother. 2007;60(6):1361-1369.
 
Wunderink RG, Mendelson MH, Somero MS, et al. Early microbiological response to linezolid vs vancomycin in ventilator-associated pneumonia due to methicillin-resistantStaphylococcus aureusChest. 2008;134(6):1200-1207.
 
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