Faculty Collaboration Database

The role of diabetes mellitus in the treatment of skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus: results from three randomized controlled trials. Int J Infect Dis 2011 Feb;15(2):e140-6

Date

12/08/2010

Pubmed ID

21134775

DOI

10.1016/j.ijid.2010.10.003

Scopus ID

2-s2.0-79551472968 (requires institutional sign-in at Scopus site)   43 Citations

Abstract

OBJECTIVE: To compare outcomes of treating complicated skin and skin structure infections (cSSSI) caused by methicillin-resistant Staphylococcus aureus (MRSA) with linezolid versus vancomycin in diabetic and non-diabetic patients.

METHODS: We pooled data from three prospective clinical trials in which 1056 patients were randomized to receive either linezolid (intravenous (IV) or oral) or vancomycin (IV) every 12h, for 7-28 days.

RESULTS: Diabetic (n=349) and non-diabetic patients (n=707) had comparable demographics and co-morbidities. Clinical success rates were lower in diabetic than in non-diabetic patients (72.3% and 85.8%, respectively). Overall, non-diabetic patients had a shorter adjusted mean length of stay (LOS) compared with diabetic patients (8.2 and 10.7 days, respectively; p<0.0001). Among diabetic patients, rates were comparable with linezolid and vancomycin treatment for clinical success (74% and 71%, respectively) and microbiological success (60% and 54%, respectively). Among non-diabetic patients, clinical and microbiological success rates were higher in linezolid- than in vancomycin-treated patients (90% and 81%, respectively, and 78% and 65%, respectively). Rates of drug-related adverse events were comparable in diabetic and non-diabetic patients and with linezolid and vancomycin treatment. Adjusted mean LOS was shorter with linezolid than with vancomycin treatment in diabetic patients (9.5 and 11.7 days, respectively; p=0.03) and non-diabetic patients (7.6 and 8.9 days, respectively; p=0.02).

CONCLUSIONS: Clinical success rates were lower in diabetic than non-diabetic patients with cSSSI caused by MRSA. Comparing linezolid and vancomycin, clinical and microbiological success rates were comparable in diabetic patients, but were better for linezolid than for vancomycin in non-diabetic patients.

Author List

Lipsky BA, Itani KM, Weigelt JA, Joseph W, Paap CM, Reisman A, Myers DE, Huang DB

MESH terms used to index this publication - Major topics in bold

Acetamides
Adult
Aged
Anti-Bacterial Agents
Diabetes Complications
Diabetic Foot
Female
Humans
Length of Stay
Linezolid
Male
Methicillin-Resistant Staphylococcus aureus
Middle Aged
Oxazolidinones
Prospective Studies
Randomized Controlled Trials as Topic
Staphylococcal Skin Infections
Treatment Outcome
Vancomycin