570. Efficacy of linezolid-based salvage therapy compared with glycopeptide-based therapy in patients with persistent methicillin-resistant Staphylococcus aureus bacteremia
Session: Poster Abstract Session: MRSA Surveillance and Infection Prevention
Friday, October 21, 2011
Room: Poster Hall B1

Background: Physicians infrequently confront patients with persistent MRSA bacteremia despite of glycopeptide therapy. However, there are limited data on the efficacy of salvage therapy in these patients. We thus evaluated the efficacy of linezolid-based salvage therapy compared with glycopeptide-based therapy in patients with persistent MRSA bacteremia.

Methods: All patients with MRSA bacteremia between August 2008 and September 2010 who were treated at Asan Medical Center, Seoul, South Korea, were prospectively enrolled. Persistent MRSA bacteremia was defined as MRSA bacteremia persisted for 7 or more days despite of glycopeptide therapy. Linezolid-based salvage therapy was classified if patients switched glycopeptides to linezolid with/without carbapenem due to persistent MRSA bacteremia.

Results: Of total 716 patients with S. aureus bacteremia, 377 (53%) revealed MRSA bacteremia. Of 377 patients with MRSA bacteremia, 90 (24%) with persistent MRSA bacteremia were included in the final analysis. Of these 90 patients, 38 (42%) were classified as linezolid-based salvage group and the remaining 52 (58%) as glycopeptide-based therapy group. The duration of persistent bacteremia (median 16 days vs. 10 days; P=0.007) and duration until negative conversion of blood culture after 7-day persistent MRSA bacteremia (median 9 days vs. 3 days; P=0.03) were longer in linezolid-based salvage group than glycopeptide-based therapy group. However, there was no significant difference in salvage success between linezolid-based salvage group and glycopeptide-based therapy group (74% vs. 70%; P=0.70). The 30-day mortality (11% vs. 25%; P=0.08) and S. aureus-related mortality (5% vs. 17%; P=0.08) had a trend toward being lower in linezolid-based salvage group than those in glycopeptide-based therapy (Detailed data shown in Table 1).

Conclusion: While linezolid-based salvage group had worse prognostic factors compared with glycopeptide-based therapy group, linezolid-based salvage therapy revealed a trend toward better outcomes than the comparator. Our data thus suggest that linezolid-based salvage therapy would be considered in patients with persistent MRSA bacteremia despite of glycopeptides therapy.


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

Hyun Jung Park, MD, Sung-Han Kim, MD, PhD, Gwang Beom Go, M.D., Yumi Lee, MD, So-Youn Park, MD, Song Mi Moon, MD, Ki-Ho Park, MD, Yong Pil Chong, MD, Sang-Oh Lee, MD, Sang-Ho Choi, MD, PhD, Jun Hee Woo, MD, PhD and Yang Soo Kim, MD, PhD, Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Disclosures:

H. J. Park, None

S. H. Kim, None

G. B. Go, None

Y. Lee, None

S. Y. Park, None

S. M. Moon, None

K. H. Park, None

Y. P. Chong, None

S. O. Lee, None

S. H. Choi, None

J. H. Woo, None

Y. S. Kim, None

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.