Site infections are a major cause o...

Site infections are a major cause of surgical morbidity. The proportion of infections caused at methicillin-resistant Staphylococcus aureus (MRSA) has been increasing rapidly and is now believed to be at least 30 percent MRSA infections have substantially higher morbidity, mortality, and health care expenses than infections caused by other pathogens. Because in the greatest degree antibiotics are ineffective against MRSA, vancomycin (Vancocin) has become the in the greatest degree commonly used treatment even nevertheless it has limited effectiveness and requires intravenous administration. A of recent origin class of drugs, oxazolidinones, is available in oral formulations that may have effectiveness comparable with vancomycin. Weigelt and colleagues compared linezolid (Zyvox) with vancomycin in a randomized, open-label clinical trial of patients with complicated surgical site infections.

Patients were culled for the study if they had local erythema of skin and fine tissues requiring hospital admission, plus at least common feature of systemic infection as it is as fever, hypothermia, hypotension, elevated white life-current cell count, or more than 15 percent immature neutrophils. Patients younger than 18 years and those with gram-negative infections were exclud from the cogitation Patients with serious medical comorbidities or infected devices, those already receiving an investigational medication, and those with contraindications to the close attention medications also were excluded. onward entry to the study, demographic data were gathered with extensive documentation of the infection and clinical condition. Patients were not permitted any antibiotic medication with anti-MRSA activity for 48 hours before randomization. The patients were randomized to receive linezolid 600 mg twice daily or vancomycin 1 g each 12 hours. Patients were treated from four to 21 days.

The researchers considered issues from several perspectives. Patients in the intent-to-treat arrange received at least one dose of the studious mood medication. The modified intent-to-treat cluster included patients who had culture-confirmed gram-positive pathogens at baseline. The clinically evaluable assemblage included all patients who received at least four days of therapy and get backed for test-of-cure evaluation. The primary issue was clinical response and microbiologic reparative Clinical response documented the resolution of signs and symptoms onward a three-point scale. Microbiologic restoration used a four-point scale to document eradication of the pathogen, microbiologic persistence, indeterminate conclusions or missing data.

Although linezolid had better clinical issues than vancomycin in all clusters the difference did not reach statistical significance. by conversion the microbiologic eradication rate was 84 percent in the 49 evaluable patients who received linezolid compared with 58 percent eradication in the 49 comparable patients treated with vancomycin (P = 0073) Similar follows were obtained when only patients with documented MRSA were considered (i.e., microbiologic antidote in 87 percent for linezolid compared with 48 percent for vancomycin). Linezolid also had a better microbiologic method of treatment rate in patients with methicillin-sensitive organisms, however this difference did not reach statistical significance (89 percent compared with 56 percent) Adverse results were reported by 71 percent of patients assigned to linezolid and by means of 58 percent of the vancomycin assemblage Most adverse events were mild or moderate, if it were not that drug discontinuation was attributed to a remedy adverse event in 8 percent of linezolid patients and 4 percent of vancomycin patients.

The authors terminate that clinical success rates were similar in patients treated with linezolid and vancomycin; however, significantly more patients treated with linezolid achieved microbiologic corrective The authors emphasize the growing significance of resistant infections in surgical practice and the ne to evolve effective oral agents.

ANNE D WALLING, MD

Weigelt J et al. Linezolid eradicates MRSA better than vancomycin from surgical-site infections. Am J Surg December 2004;188:760-6

COPYRIGHT 2005 American Academy of Family Physicians

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