PMID- 33785363
OWN - NLM
STAT- MEDLINE
DCOM- 20211018
LR  - 20211018
IS  - 1872-7913 (Electronic)
IS  - 0924-8579 (Linking)
VI  - 57
IP  - 5
DP  - 2021 May
TI  - Comparison of linezolid step-down therapy to standard parenteral therapy in 
      methicillin-resistant Staphylococcus aureus bloodstream infections.
PG  - 106329
LID - S0924-8579(21)00065-0 [pii]
LID - 10.1016/j.ijantimicag.2021.106329 [doi]
AB  - Data supporting oral step-down therapy in methicillin-resistant Staphylococcus 
      aureus (MRSA) bloodstream infection (BSI) are sparse; linezolid offers potential 
      in this setting. This study aimed to determine the effectiveness and safety of 
      oral step-down linezolid compared with standard parenteral therapy (SPT) in 
      MRSA-BSI. This was a retrospective cohort performed in adults receiving 
      step-down/outpatient linezolid or SPT (vancomycin, daptomycin) for MRSA-BSI from 
      2011-2019. Primary outcome was 90-day infection-related re-admission (IRR) from 
      clinical worsening/relapse or infection recurrence. 215 patients included (54 
      linezolid, 161 SPT). Infection sources were skin (34%), bone/joint (15%), 
      endocarditis (13%), other (32%), multiple (6%). Patients receiving SPT more 
      commonly had complicated bacteraemia (72% vs. 41%; P < 0.0001) and metastatic 
      foci (45% vs. 20%; P = 0.001). 90-day IRR occurred in 17% and 26% of linezolid 
      and SPT groups, respectively (P = 0.159). When accounting for disease severity, 
      linezolid use was not independently associated with 90-day IRR (adjOR, 1.0, 95% 
      CI 0.24-4.3; P = 0.986). There were no differences in all-cause 90-day mortality 
      (4% vs. 6%, P = 0.487) or overall incidence of drug-related adverse events (AEs) 
      (17% vs. 16%; P = 0.843) between the groups. More patients in the SPT group 
      developed an AE requiring re-hospitalisation (12% vs. 2%; P = 0.024), most 
      commonly line-related complications. Oral step-down linezolid demonstrated 
      similar clinical and safety outcomes compared with SPT for MRSA-BSI, except 
      linezolid was associated with fewer AEs requiring re-hospitalisation. Additional 
      research is needed exploring step-down linezolid in MRSA-BSI, particularly in 
      patients requiring shorter durations of outpatient therapy.
CI  - Copyright (c) 2021 Elsevier Ltd. All rights reserved.
FAU - Yeager, Samantha D
AU  - Yeager SD
AD  - Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN 
      37920, USA.
FAU - Oliver, Justin E
AU  - Oliver JE
AD  - Department of Clinical Pharmacy and Translational Science, College of Pharmacy, 
      University of Tennessee Health Science Center, Knoxville, TN 37920, USA.
FAU - Shorman, Mahmoud A
AU  - Shorman MA
AD  - Division of Infectious Diseases, University of Tennessee Medical Center, 
      Knoxville, TN 37920 USA; Graduate School of Medicine, University of Tennessee 
      Health Science Center, Knoxville, TN 37920, USA.
FAU - Wright, Laurence R
AU  - Wright LR
AD  - Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN 
      37920, USA.
FAU - Veve, Michael P
AU  - Veve MP
AD  - Department of Pharmacy, University of Tennessee Medical Center, Knoxville, TN 
      37920, USA; Department of Clinical Pharmacy and Translational Science, College of 
      Pharmacy, University of Tennessee Health Science Center, Knoxville, TN 37920, 
      USA. Electronic address: mpveve@wayne.edu.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20210327
PL  - Netherlands
TA  - Int J Antimicrob Agents
JT  - International journal of antimicrobial agents
JID - 9111860
RN  - 0 (Anti-Bacterial Agents)
RN  - 6Q205EH1VU (Vancomycin)
RN  - ISQ9I6J12J (Linezolid)
RN  - NWQ5N31VKK (Daptomycin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Daptomycin/*therapeutic use
MH  - *Drug Administration Routes
MH  - Female
MH  - Humans
MH  - Linezolid/*therapeutic use
MH  - Male
MH  - Methicillin-Resistant Staphylococcus aureus/*drug effects
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Sepsis/*drug therapy
MH  - Staphylococcal Infections/drug therapy
MH  - Treatment Outcome
MH  - Vancomycin/*therapeutic use
OTO - NOTNLM
OT  - Bacteraemia
OT  - Daptomycin
OT  - Linezolid
OT  - Methicillin-resistant Staphylococcus aureus
OT  - Oral step-down therapy
OT  - Vancomycin
EDAT- 2021/04/01 06:00
MHDA- 2021/10/21 06:00
CRDT- 2021/03/31 05:53
PHST- 2020/08/23 00:00 [received]
PHST- 2021/02/19 00:00 [revised]
PHST- 2021/03/20 00:00 [accepted]
PHST- 2021/04/01 06:00 [pubmed]
PHST- 2021/10/21 06:00 [medline]
PHST- 2021/03/31 05:53 [entrez]
AID - S0924-8579(21)00065-0 [pii]
AID - 10.1016/j.ijantimicag.2021.106329 [doi]
PST - ppublish
SO  - Int J Antimicrob Agents. 2021 May;57(5):106329. doi: 
      10.1016/j.ijantimicag.2021.106329. Epub 2021 Mar 27.