14th ICID - Poster Abstracts - International Society for Infectious ...

When citing these abstracts please use the following reference:
Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number.
Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1
is available electronically on http://www.sciencedirect.com
Final Abstract Number: 77.021
Session: Gram-positives & Miscellaneous Pathogens
Date: Friday, March 12, 2010
Time: 12:30-13:30
Room: Poster & Exhibition Area/Ground Level
Type: Poster Presentation
Effectiveness of linezolid versus vancomycin treatment for MRSA skin and soft tissue infections
M. Yim, J. Steingisser, R. Kan, A. Nshala, R. Larson
Dartmouth College, Hanover, NH, USA
Background: Methicillin-resistant Staphylococcus aureus (MRSA) infections of skin and soft
tissues are an increasing concern in hospital and community settings. Whether newer agents like
linezolid offer efficacy, safety or cost advantages over traditional first line treatment with
vancomycin is not known. We conducted a systematic review and meta-analysis to assess the
safety and efficacy of linezolid compared to vancomycin in hospitalized patients with presumed
MRSA infections of skin or soft tissue.
Methods: In October 2009, we searched MEDLINE (1950-2009), Web of Science (1900-2009),
both the Cochrane Database of Systematic Reviews and CENTRAL (Issue 4, 2009),
ClinicalTrials.gov, relevant conference proceedings and reference lists using no limits. We
selected randomized controlled trials comparing linezolid (intravenous or oral) versus vancomycin
(intravenous) in non-surgical hospitalized patients with MRSA-infected or suspected skin or soft
tissue infections who were followed for a minimum of 7 days. Two independent reviewers
extracted data from each qualifying report using a standard data collection form. We used
Cochrane Collaboration's risk of bias tool to assess methodological quality and data was
summarized in RevMan using random effects models.
Results: Of 455 reports identified, 7 studies qualified for inclusion. Linezolid was favored over
vancomycin for clinical cure rate (RR 0.79; 95% CI 0.67, 0.94; P = 0.007) and microbiological
eradication rate ( RR 0.80; 95% CI 0.62, 1.04; P = 0.10). Analysis of adverse events revealed no
difference between the two agents (RR 0.98; 95% CI 0.76, 1.27; P = 0.90). Results for length of
stay were inconclusive.
Conclusion: Our results suggest that linezolid is more effective than vancomycin for achieving
clinical cure in hospitalized patients with MRSA skin and soft tissue infections while adverse
events are no different. However, other important benefits and tradeoffs such as length of stay,
resistance, and cost would be important to explore before changing current practice.