Clinical Outcome And Cost Study Of Vancomycin And Linezolid As Treatment Of Pneumonia Due To Methicillin-resistant Staphylococcus Aureus

BackgroundMethicillin-resistant Staphylococcus Aureus (MRSA) is a hospital associated bacterium, which is resistant to all β-lactam antibiotics. MRSA pneumonia is a life-threatening respiratory disease, which is a common and serious infection among MRSA infections. In our country, MRSA pneumonia is the most common hospital-acquired pneumonia. Comparing to normal hospital-acquired pneumonia, MRSA pneumonia is resulted in longer hospital stay and additional medical expenses. The disease burden of MRSA pneumonia is considered heavy because it is not only associated with hospital mortality but also health resource utilization. Vancomycin and linezolid have served as standard treatments of MRSA pneumonia in current China. It is quite easier to find some studies comparing the efficacy between vancomycin and linezolid, but there is no cost-effectiveness studies between two drugs in real world.This study was designed to compare the clinical outcomes and costs between vancomycin and linezolid as treatment of MRSA pneumonia based on the electronic medical records database from one tertiary comprehensive hospital in Shanghai, with the purpose to provide suggestions in treatment selection for clinicians.Objective1) Compare the clinical outcomes between vancomycin and linezolid2) Compare the in-hospital cost between vancomycin and linezolidMethodologyThis study includes patients who were hospitalized between January 29, 2008 and February 23,2012 and received vancomycin or linezolid for MRSA pneumonia, which includes 1226 patients treated with vancomycin and 129 patients treated with linezolid. This study used propensity score matching to balance the general baseline variations between two treatments. A total number of 95 pairs were identified applying greedy matching. Clinical outcomes were compared in unmatched and matched samples while cost-effectiveness was only compared in matched sample.ResultsUnmatched sample:The cure rates of vancomycin and linezolid in treating MRSA pneumonia were 21.04% and 27.91%(p=0.091). The all-cause mortality at discharge of vancomycin and linezolid were 5.55% and 19.38%(p<0.001)Matched sample:The cure rates of vancomycin and linezolid in treating MRSA pneumonia were 27.37% and 30.53%(p=0.631).The all-cause mortality at discharge of vancomycin and linezolid were 4.21% and 18.95%(p=0.003)。With linezolid, incremental MRSA treatment cost and total in-hospital cost per patient cured were 151839RMB and 956935RMB respectively. With linezolid, incremental MRSA treatment cost and total in-hospital cost per death avoided were -31804RMB and -200439RMB respectively.Conclusions1. In unmatched sample, vancomycin was more efficacious than linezolid in treating MRSA pneumonia.2. In matched sample, vancomycin was more efficacious than linezolid in treating MRSA pneumonia, as well.3. Vancomycin was more cost-effective than linezolid in treating MRSA pneumonia.