Journal Article

Linezolid versus vancomycin for <i>Staphylococcus aureus</i> bacteraemia: pooled analysis of randomized studies

Andrew F. Shorr, Mark J. Kunkel and Marin Kollef

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 56, issue 5, pages 923-929
Published in print November 2005 | ISSN: 0305-7453
Published online September 2005 | e-ISSN: 1460-2091 | DOI: http://dx.doi.org/10.1093/jac/dki355
Linezolid versus vancomycin for Staphylococcus aureus bacteraemia: pooled analysis of randomized studies

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  • Medical Oncology
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Objectives: To compare outcomes in patients with Staphylococcus aureus bacteraemia treated with linezolid with those of vancomycin-treated patients.

Methods: We pooled and analysed five randomized studies comparing linezolid with vancomycin, focusing on the 144 adults with S. aureus bacteraemia, which was secondary in >70% of patients. Efficacy variables were clinical cure of primary infection, microbiological success (eradication of S. aureus from blood or presumed eradication based on clinical cure of primary infection), survival, and outcome predictors identified by multivariate logistic regression.

Results: Of 99 clinically evaluable patients, primary infection was cured in 28 (55%) of 51 linezolid recipients and 25 (52%) of 48 vancomycin recipients [odds ratio (OR) for cure with linezolid versus vancomycin, 1.12; 95% confidence interval (CI), 0.51–2.47]. There were no between-group differences in the meta-analysis (OR, 1.16; 95% CI, 0.5–2.65). Of 53 evaluable patients with methicillin-resistant S. aureus (MRSA) bacteraemia, clinical cure occurred in 14 (56%) of 25 linezolid recipients and 13 (46%) of 28 vancomycin recipients (OR, 1.47; 95% CI, 0.50–4.34). Microbiological success occurred in 41 (69%) of 59 linezolid recipients and 41 (73%) of 56 vancomycin recipients (OR, 0.83; 95% CI, 0.37–1.87). Fifty-five (74%) of 74 linezolid recipients survived versus 52 (74%) of 70 vancomycin recipients (OR, 1.00; 95% CI, 0.47–2.12). In the multivariate analysis, treatment group was not a significant predictor of clinical cure or survival.

Conclusions: Linezolid was associated with outcomes that were not inferior to those of vancomycin in patients with secondary S. aureus bacteraemia.

Keywords: methicillin-resistant Staphylococcus aureus; survival; thrombocytopenia

Journal Article.  5733 words.  Illustrated.

Subjects: Medical Oncology ; Critical Care

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