The effect of diabetes mellitus on outcomes of patients with nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus: data from a prospective double-blind clinical trial comparing treatment with linezolid versus vancomycin

BMC Infectious Diseases

Research Article

Christopher da Costa¹  Ozlem Equils¹  Michele Wible¹  Benjamin A. Lipsky² 

[1] Pfizer Inc., Collegeville, PA, USA;University of Oxford, Oxford, UK;University of Washington, Seattle, WA, USA;

关键词: Linezolid;    Diabetes mellitus;    MRSA;    Vancomycin;    Pneumonia;    Mortality;    Outcome;    Staphylococcus;    Infection;    Prognosis;   

DOI  :  10.1186/s12879-016-1779-5

 received in 2015-06-29, accepted in 2016-08-15,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe presence of diabetes mellitus increases the risk of several severe infections, but data on its effect on treatment outcomes in patients with nosocomial pneumonia (NP) caused by methicillin-resistant Staphylococcus aureus (MRSA) are limited.MethodsWe retrospectively analyzed data from a double-blind, randomized, multi-center, international clinical trial of culture-confirmed MRSA NP that compared treatment with linezolid to vancomycin. Specifically, we evaluated the clinical and microbiologic outcomes of patients with and without diabetes in the modified intent to treat population at end-of-treatment (EOT) and end-of-study (EOS, 7–30 days post-EOT).ResultsAmong 448 enrolled patients 183 (40.8 %) had diabetes mellitus, 87 (47.5 %) of whom received linezolid and 96 (52.5 %) vancomycin. Baseline demographic and clinical characteristics were similar for the two treatment groups. Clinical success rates at EOS were 57.6 % with linezolid and 39.3 % with vancomycin, while microbiological success rates were 58.9 % with linezolid and 41.1 % with vancomycin. Among diabetic patients, rates of mortality and study drug-related adverse effects were similar between the treatment groups. Overall day 28 mortality rates were higher among diabetic patients compared to non-diabetic patients (23.5 vs 14.7 %, respectively: RD = 8.8 %, 95 % CI [1.4, 16.3]).ConclusionsAmong diabetic patients with MRSA NP, treatment with linezolid, compared to vancomycin, was associated with higher clinical and microbiologic success rates, and comparable adverse event rates.Trial registrationNCT00084266.

【 授权许可】

CC BY   
© The Author(s). 2016