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JAC Advance Access originally published online on September 29, 2005
Journal of Antimicrobial Chemotherapy 2005 56(5):923-929; doi:10.1093/jac/dki355
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Linezolid versus vancomycin for Staphylococcus aureus bacteraemia: pooled analysis of randomized studies

Andrew F. Shorr1,*, Mark J. Kunkel2 and Marin Kollef3

1 Pulmonary, Critical Care & Respiratory Services, Washington Hospital Center, 110 Irving Street NW, Room 2A38-D, Washington, DC 20010, USA; 2 Pfizer Inc., 235 E. 42nd Street, New York, NY 10017, USA; 3 Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA

Received 10 February 2005; returned 14 March 2005; revised 1 September 2005; accepted 8 September 2005

* Corresponding author. Tel: +1-202-877-2998; E-mail: AFSHORR{at}mail.dnamail.com

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


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