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Deprecated: Implicit conversion from float 243.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Pharmacotherapy 2016 ; 36 (7): 731-9 Nephropedia Template TP
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Comparison of Linezolid and Vancomycin for Methicillin-resistant Staphylococcus aureus Pneumonia: Institutional Implications #MMPMID27208687
Tong MC; Wisniewski CS; Wolf B; Bosso JA
Pharmacotherapy 2016[Jul]; 36 (7): 731-9 PMID27208687show ga
Objective: Recent studies suggesting clinical superiority of linezolid over vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia led to a change in our institution?s clinical pathway/order form for hospital-acquired pneumonia, positioning linezolid as the preferred agent. Our objective was to assess the impact of this change within our institution. Design: Retrospective electronic medical records review Methods: The analysis for this observational study included eligible patients admitted to our medical center between May 1, 2011 and August 31, 2014 , with ICD-9 codes for MRSA and pneumonia. Included patients were at least 18 years of age and had vancomycin or linezolid initiated at least 2 days after admission and continued for at least 2 consecutive days. The primary endpoints were extent of antibiotic use before and after order form change and length of stay (LOS) and hospital charges in the two treatment groups. A secondary aim was to detect any gross discrepancies in patient outcomes such as treatment duration, mechanical ventilation duration, all-cause mortality rate, nephrotoxicity, and 30-day readmission between the two treatment groups. Measurements and Main Results: Outcomes in 227 patients were assessed. Linezolid use increased 16.2% subsequent to the change in the order form. Although not statistically significant, the median hospital admission charge was $6,200 lower in patients treated with linezolid compared with those treated with vancomycin ($25,900 vs. $32,100). Hospital LOS was significantly associated with Charlson comorbidity index (P < 0.001), the type of treatment (p = 0.032), duration of treatment (p < 0.001), mechanical ventilation (p < 0.001), and ICU admission (p < 0.001). All-cause mortality favored linezolid treatment and these patients were more likely to be discharged (shorter LOS). Conclusions: Although linezolid use increased markedly with this pathway/order form change, no negative institutional consequences or unfavorable patient outcomes were detected, justifying the change in policy from these perspectives.
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Pharmacotherapy 2016 ; 36 (7): 731-9
