The burden of methicillin-resistant Staphylococcus aureus (MRSA)
nosocomial pneumonia in the People's Republic of China is high, with methicillin-resistance rates greater than 80% reported for patients with S. aureus
pneumonia treated in intensive care units. Historically,
vancomycin was the treatment of choice for patients with hospital-acquired MRSA
infections. Recent evidence suggests that the minimum inhibitory concentration for
vancomycin is increasing. Additionally, patients treated with
vancomycin require monitoring of
vancomycin trough concentrations and can develop nephrotoxicity.
Linezolid is a treatment option for patients with hospital-acquired MRSA
infections that can be administered either intravenously or orally. Analysis of data from a worldwide
linezolid surveillance program initiated in the year 2004 shows no evidence of increasing
linezolid minimum inhibitory concentrations. The clinical efficacy of
linezolid for patients with gram-positive, including MRSA,
nosocomial pneumonia, was evaluated in numerous studies. In general, results from these studies show higher or similar clinical success with no mortality difference for
linezolid compared to
vancomycin treated patients. Results from a Phase IV study enrolling patients with MRSA-confirmed
nosocomial pneumonia suggest higher clinical cure rates for
linezolid compared to
vancomycin treated patients. Although acquisition costs are higher for
linezolid compared to
vancomycin therapy, evidence suggests similar overall medical costs. Cost-analysis results from a Chinese perspective show that
linezolid dominated
vancomycin therapy for MRSA
nosocomial pneumonia in ∼35% of bootstrap simulations whereas
vancomycin dominated
linezolid in less than 2% of bootstrap simulations. In summary, results from both clinical and economic studies, including studies conducted from a Chinese perspective, support the use of
linezolid for the treatment of patients with MRSA
nosocomial pneumonia.