572. The Impact of Linezolid (LZD) and Vancomycin (VAN) Treatment on the Resolution of Signs and Symptoms of Nosocomial Pneumonia (NP)  Caused by Culture Proven Methicillin-Resistant Staphylococcus aureus (MRSA) Among Ventilated Patients
Session: Poster Abstract Session: MRSA Surveillance and Infection Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • ZY11-094 LZD VAN Impact - IDSA11.pdf (336.4 kB)
  • Background: In a double-blind randomized controlled trial (DBRCT) for treatment of NP caused by culture proven MRSA, LZD demonstrated a higher clinical cure rate vs VAN at end of study (EOS) in the per-protocol population (57.6% vs 46.6%, respectively). We assessed the effects of LZD and VAN on signs and symptoms of NP caused by culture-proven MRSA among ventilated patients.

    Methods:  Patients enrolled in the DBRCT were treated with LZD (600 mg twice daily) or VAN (15 mg/kg twice daily) for 7-14d. Data was collected on vital signs, laboratory parameters and signs and symptoms of NP during the course of the study. 

    Results: Among ventilated patients, on Day3, although not statistically significant, % decrease from baseline was greater for rales (-22% vs -12%, P=0.09), pulmonary consolidation (dullness on percussion, bronchial breath sounds, or egophony; -19% vs -10%, P=0.08), and hypoxemia (-34% vs -22%, P=0.09) in LZD- vs VAN-treated patients. There was no difference in resolution of fever, purulent sputum, and normalization of vital signs between the LZD and VAN groups. At end of treatment (EOT), more LZD- vs VAN-treated patients had resolution of chest X-ray findings (Table).

    Conclusion:   The results suggest earlier resolution of certain signs and symptoms on Day3, and normalization of chest X-ray at EOT in NP MRSA patients treated with LZD vs VAN. 

    Table. Resolution of signs and symptoms of MRSA NP among ventilated patients treated with LZD or VAN in the per-protocol population

     

                          

         LZD (n=126)

    VAN (n=141)

    P-value

    Rales

    Baseline N (%)

    94 (75%)

    105 (75%)

    1.00

    EOT change from baseline/N#   (%)

    -54/86 (-63%)

    -63/97 (-65%)

    0.88

    Pulmonary consolidation

    Baseline N (%)

    103 (82%)

    117 (84%)

    0.75

    EOT change from baseline/N#   (%)

    -63/95 (-66%)

    -59/109 (-54%)

    0.09

    Hypoxemia

    Baseline N (%)

    89 (71%)

    101 (72%)

    0.89

    EOT change from baseline/N#   (%)

    -48/82 (-59%)

    -48/92 (-52%)

    0.45

    WBC (>10,000/mm3)

    Baseline N (%)

     107 (85%)

    118 (84%)

    0.87

    EOT change from baseline/N#   (%)

     -40/103 (-39%)

    -35/108 (-32%)

    0.39

    Chest X-ray
    N (%)

    Baseline Bilateral

    93 (74%)

    88 (62%)

    0.05

    Baseline Unilateral

    32 (26%)

    53 (38%)

    0.05

    EOT  Resolved

    108 (89%)

    89 (70%)

    <0.01

    For categorical variables Fisher exact test was used. Missing values are excluded from analyses. 
    # Number of subjects having both baseline and visit observations.


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Ethan Rubinstein, University of Manitoba, Winnipeg, MB, Canada, David Huang, MD, PhD, MPH, Specialty Care Medicines Development Group, Pfizer Inc, Collegeville, PA and Ozlem Equils, M.D., Pfizer Inc, Collegeville, PA

    Disclosures:

    E. Rubinstein, Pfizer Inc: Consultant, Consulting fee
    Theravance: Consultant, Consulting fee
    Astellas: Consultant, Consulting fee
    Bayer: Consultant, Consulting fee
    Atox-Bio: Consultant, Consulting fee
    BiondVax: Consultant, Consulting fee

    D. Huang, Pfizer Inc: Employee, Salary

    O. Equils, Pfizer Inc: Employee, Salary

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