Clinical outcomes of linezolid and vancomycin in patients with nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus stratified by baseline renal function: a retrospective, cohort analysis

BMC Nephrology

Research Article

Ping Liu¹  Amy Stein²  Ali A. El-Solh³  Blair Capitano⁴ 

[1] Clinical Pharmacology, Global Established Pharma Business, Pfizer Inc, Groton, CT, USA;Customer Solutions, Biostatistics, Quintiles, Durham, NC, USA;Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, Buffalo, NY, USA;VA Western New York Healthcare System, Medical Research, Bldg. 20 (151) VISN02, 3495 Bailey Avenue, 14215-1199, Buffalo, NY, USA;Medical Affairs, Specialty Care, Pfizer Inc., Collegeville, PA, USA;

关键词: Outcomes;    Linezolid;    Vancomycin;    Pneumonia;    MRSA;    Renal function;   

DOI  :  10.1186/s12882-017-0581-y

 received in 2015-10-26, accepted in 2017-05-12,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe primary objective of this study is to assess whether baseline renal function impacts treatment outcomes of linezolid and vancomycin (with a dose-optimized regimen) for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.MethodsWe conducted a retrospective cohort analysis of data generated from a prospective, randomized, controlled clinical trial (NCT 00084266). The analysis included 405 patients with culture-proven MRSA pneumonia. Baseline renal function was stratified based on creatinine clearance.Clinical and microbiological success rates and presence of nephrotoxicity were assessed at the end of treatment (EOT) and end of study (EOS). Multivariate logistic regression analyses of baseline patient characteristics, including treatment, were performed to identify independent predictors of efficacy. Vancomycin concentrations were analyzed using a nonlinear mixed-effects modeling approach. The relationships between vancomycin exposures, pharmacokinetic-pharmacodynamic index (trough concentration, area under the curve over a 24-h interval [AUC0–24], and AUC0–24/MIC) and efficacy/nephrotoxicity were assessed in MRSA pneumonia patients using univariate logistic regression or Cox proportional hazards regression analysis approach.ResultsAfter controlling for use of vasoactive agents, choice of antibiotic therapy and bacteremia, baseline renal function was not correlated with clinical and microbiological successes in MRSA pneumonia at either end of treatment or at end of study for both treatment groups. No positive association was identified between vancomycin exposures and efficacy in these patients. Higher vancomycin exposures were correlated with an increased risk of nephrotoxicity (e.g., hazards ratio [95% confidence interval] for a 5 μg/ml increase in trough concentration: 1.42 [1.10, 1.82]).ConclusionsIn non-dialysis patients, baseline renal function did not impact the differences in efficacy or nephrotoxicity with treatment of linezolid versus vancomycin in MRSA pneumonia.

【 授权许可】

CC BY   
© The Author(s). 2017