571. The Impact of Linezolid (LZD) Versus Vancomycin (VAN) on Surgical Interventions (SI) for Complicated Skin and Skin Structure Infections (cSSSI) Caused by Methicillin-Resistant Staphylococcus aureus (MRSA)
Session: Poster Abstract Session: MRSA Surveillance and Infection Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • ZY11-098 LZD Impact SI - IDSA11 Final.pdf (826.8 kB)
  • Background:  We determined the impact of LZD compared with VAN on the need for surgical interventions (SI) in the management of MRSA cSSSI.

    Methods:  Data from a prospective, randomized trial evaluating the safety and efficacy of LZD 600 mg IV or PO q12h and VAN 15mg/kg IV q12h (adjusted for creatinine clearance) to be given for 7-14 days to treat MRSA cSSSI were analyzed. We included patients who received ≥ 1 dose of drug and had a cSSSI due to culture proven MRSA. Patients who underwent incision/drainage, excision/debridement, surgical closure or amputation were categorized as SI patients. SI type and frequency were assessed, per patient, during specific time periods as follows: study days (D) 1-3, estimate of time to reach steady-state drug levels; D4 – 14, drug treatment period; D 15 – 28, post drug treatment until end of study. Independent predictors of ≥ 2 SI during the drug treatment period were identified by logistic regression.

    Results:  640 patients were included in the analysis (322 LZD; 318 VAN); 323 had ≥ 1 SI (167 LZD; 156 VAN). Baseline characteristics were similar between treatment groups among SI patients. The majority of patients (83.2% LZD, 83.3% VAN) underwent initial SI within D1-3. The most common cSSSIs among SI patients were abscess (59%), surgical wound infection (14%) and infected ulcer (20%). There were 39 patients with ≥ 2 SI during D1-3 [18 (11%) LZD, 21(14%) VAN, p = 0.50]; 24 with ≥2 SI during D4-14 [5 (3%) LZD, 19 (12%) VAN, P = 0.002];12 with ≥ 2 SI within D15-28 [7(4%) LZD, 5(3%) VAN, p = 0.77].

    Independent predictors of ≥ 2 SI during D4 – 14 were:

     

    Parameter

    OR

    95% CI

    VAN treatment

    4.90

    1.71, 14.09

    Polymicrobial infection

    3.21

    1.29, 7.94

    Ex-US region

    2.87

    0.99, 8.37

    Lower extremity cSSSI

    2.24

    0.92, 5.47

    Induration width

    1.05

    1.02, 1.09

    Conclusion:  Patients who received LZD in the management of MRSA cSSSI had a lower probability of undergoing ≥2 SI during the treatment period of 4-14 days, when a steady state drug level is estimated to be achieved, as compared with VAN-treated patients. Other predictive factors of multiple SIs during the study period were management outside of the US, extent of wound induration, lower extremity infection, and polymicrobial infection. In our study, the type of antibiotic was the only modifiable predictor of increased SI rates.


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

    Therese M. Duane, MD1, Blair Capitano, PharmD2, Laura A. Puzniak, PhD, MPH2, Pinaki Biswas, PhD2, David Huang, MD, PhD, MPH3 and Manjari Joshi, MBBS4, (1)Division of Trauma, Critical Care, Emergency General Surgery, Virginia Commonwealth University Health System, Richmond, VA, (2)Pfizer Inc, Collegeville, PA, (3)Specialty Care Medicines Development Group, Pfizer Inc, Collegeville, PA, (4)Division of Infectious Diseases, Program of Traumatology, R.A. Cowley Shock Trauma Center, University of Maryland, Baltimore, MD

    Disclosures:

    T. M. Duane, Pfizer Inc: Consultant, Consulting fee

    B. Capitano, Pfizer Inc: Employee, Salary

    L. A. Puzniak, Pfizer Inc: Employee, Salary

    P. Biswas, Pfizer Inc: Employee, Salary

    D. Huang, Pfizer Inc: Employee, Salary

    M. Joshi, Pfizer Inc: Consultant, Grant Investigator, Independent Contractor, Scientific Advisor and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
    Synthes, Inc.: Consultant, Grant Investigator and Scientific Advisor, Consulting fee and Research grant
    Atox Bio: Consultant and Grant Investigator, Nothing to date
    Innovative Biosensors: Grant Investigator, Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.