Methicillin-resistant Staphylococcus aureus nosocomial pneumonia: role of linezolid in the People’s Republic of China

Figures & data

Table 1 Summary of results for studies reporting Staphylococcus aureus resistance to methicillin in the People’s Republic of China

Reference	Chinese sites, n	Date isolates obtained	Infection type	S. aureus
				Isolates, n	MR isolates, n (%)
Chen et al^Citation12	4	2009–2011	BS	108	62 (57.4)
Chen et al^6,a	13	2011	BS, HAP, IA	NR	NR (64.4)
Jones et al^Citation13	12	2011	BS, RT, SSS	343	157 (45.8)
Lu et al^14,a	18	2007–2008	BS	37	20 (54.1)
		2009–2010		170	62 (36.5)
Reinert et al^Citation15	2	2004–2006	Various	NR	NR (59.1)
Sun et al^16,a	12	2009	NR	466	211 (45.3)
Wang et al^Citation17	16	2008	NR	798	403 (50.5)
Wei et al^Citation18	1	2008–2011	Various	690	391 (56.7)
Zhao et al^Citation7	12	2005–2010	Various	2,245	1,050 (46.8)
			Respiratory	735	496 (67.5)
			SSS	771	211 (27.4)
Zou et al^Citation19	11	2006–2008	Various	293	190 (64.8)

Notes:

a Data taken from abstract; article in Chinese.

Abbreviations: BS, bloodstream; HAP, hospital-acquired pneumonia; IA, intra-abdominal; MR, methicillin-resistant; NR, not reported; RT, respiratory tract; SSS, skin and skin structure.

Table 2 Clinical cure and organism eradication rates for linezolid and vancomycin treatment groups in randomized studies enrolling patients with known or suspected gram-positive nosocomial pneumoniaa

Population or subgroup	Patients, n/N (%)b		95% CI for differencec
	Linezolid	Vancomycin
Rubinstein et al^Citation31
Clinical cure
ITT	86/161 (53.4)	74/142 (52.1)	NR
CEa	71/107 (66.4)	62/91 (68.1)	−14.9 to 11.3
MEb	36/53 (67.9)	28/39 (71.8)	−22.8 to 15.0
Organism eradication
Staphylococcus aureus	25/41 (61.0)	15/23 (65.2)	NR
MR S. aureus	15/23 (60.9)	7/9 (77.8)	NR
Streptococcus pneumoniae	9/9 (100)	9/9 (100)	NR
Wunderink et al^Citation33
Clinical cure
ITT	135/256 (52.7)	128/245 (43.5)	−8.3 to 9.2
CEa	114/168 (67.9)	111/171 (43.5)	−7.1 to 13.0
ME	47/76 (61.8)	42/78 (92.3)	−6.9 to 24.2
Organism eradication
S. aureus	28/52 (53.8)	27/62 (43.5)	−8.0 to 28.6
MR S. aureus	12/19 (63.2)	10/23 (43.5)	NR
S. pneumoniae	14/18 (77.8)	12/13 (92.3)	−38.6 to 9.5
Lin et al^Citation35
Effective treatment rate
EOT	22/28 (78.6)	18/34 (52.9)	2.99 to 48.3
FU	19/26 (73.1)	18/33 (54.5)	−5.5 to 42.6
Pathogen eradication rate
Gram-positive pneumonia	17/22 (77.3)	15/28 (53.6)	−1.75 to 49.16
S. aureus	14/18 (77.8)	11/21 (52.4)	NR

Notes:

a Only data presented for patients with known or suspected gram-positive pneumonia;

b data presented as n/N where n equals the number of patients with a response and N equals the number of patients evaluated;

c CI for difference between clinical success rates for linezolid minus those for vancomycin.

Abbreviations: CI, confidence interval; CE, clinically evaluable; EOT, end of treatment; FU, follow-up; ITT, intent to treat; ME, microbiologically evaluable; MR, methicillin-resistant; NR, not reported.

Table 3 Meta-analyses results for studies comparing linezolid and vancomycin therapy in patients with gram-positive pneumonia

Reference	Studies, n	Patients, n/Na		Outcome LIN vs VANb	P-value
		LIN	VAN
Wang et al^Citation49	9	551	519	Clinical cure: RR 1.08 (0.98–1.18)	0.11
	4	171	163	MRSA clinical cure: RR 1.16 (0.95–1.43)	0.15
	7	318	282	Micro success: RR 1.12 (0.96–1.30)	0.15
	6	130	107	MRSA eradication: RR 1.16 (0.93–1.45)	0.19
	4	1,196	1,156	Mortality: RR 0.88 (0.74–1.05)	0.16
	4	1,196	1,156	Nephrotoxicity: RR 0.50 (0.31–0.81)	0.005
	4	1,196	1,156	Thrombocytopenia: RR 0.77 (0.35–1.60)	0.51
	4	1,196	1,156	Gastrointestinal effects: RR 1.33 (0.76–2.34)	0.32
Jiang et al^Citation44	10	380/605	328/544	Tx success: RR 1.09 (95% CI: 0.99–1.19)	0.07
	8	234/391	196/375	Micro success: RR 1.16 (95% CI: 1.02–1.31)	0.02
	12c	NR	NR	Mortality: RR 0.95 (95% CI: 0.83–1.09)	0.46
	9c	NR	NR	Anemia: RR 1.14 (95% CI: 0.73–1.79)	0.55
	9c	NR	NR	Thrombocytopenia: RR 1.58 (95% CI: 0.75–3.33)	0.23
	9c	NR	NR	Renal: RR 0.41 (95% CI: 0.27–0.64)	<0.001
Bally et al^Citation40	3	240/563	217/527	Clin success: OR 1.06 (95% CI: 0.75–1.51)	NR
	2d	114/209	106/231	Clin success MRSA: OR 1.37 (95% CI: 0.72–2.44)	NR
	3	NR/1,021	NR/1,082	Mortality: OR 0.85 (95% CI: 0.58–1.22)	NR
	3	NR/874	NR/852	Serious AE: OR 0.93 (95% CI: 0.62–1.32)	NR
Beibei et al^Citation41	7	253/398	229/360	Clin success: OR 1.16 (95% CI: 0.85, 1.57)	NR
Lin et al^47,e	7	NR	NR	Clin success: OR 1.11 (95% CI: 0.82–1.53)	>0.05
	7	NR	NR	Mortality: OR 0.80 (95% CI: 0.59–1.07)	>0.05
	7	NR	NR	AE: OR 1.06 (95% CI: 0.68–1.64)	>0.05

Notes:

a n Equals number of successfully treated patients, N equals the total number of patients; data presented as number of successfully treated patients;

b data presented as OR or RR (95% CI);

c comparison between linezolid and glycopeptides;

d patients with confirmed MRSA pneumonia;

e article published in Chinese; data obtained from English abstract.

Abbreviations: AE, adverse event; Clin, clinical; CI, confidence interval; LIN, linezolid; Micro, microbiologic; NR, not reported; RR, risk ratio; Tx, treatment; VAN, vancomycin; MRSA, methicillin-resistant Staphylococcus aureus; OR, odds ratio.

Figure 1 Mean cost by treatment for patients enrolled in the ZEPHyR trial (modified intent-to-treat population).

Note: Reprinted from Clinical Therapeutics, 36(9), Niederman MS, Chastre J, Solem CT, et al, Health economic evaluation of patients treated for nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus: secondary analysis of a multicenter randomized clinical trial of vancomycin and linezolid, 1233–1243. Copyright 2014, with permission from Elsevier.⁵⁰
Abbreviation: MV, mechanical ventilation.

Figure 2 Mean cost by renal failure status for patients enrolled in the ZEPHyR trial (modified intent-to-treat population).

Note: Reprinted from Clinical Therapeutics, 36(9), Niederman MS, Chastre J, Solem CT, et al, Health economic evaluation of patients treated for nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus: secondary analysis of a multicenter randomized clinical trial of vancomycin and linezolid, 1233–1243. Copyright 2014, with permission from Elsevier.⁵⁰
Abbreviation: MV, mechanical ventilation.

Figure 3 Mean cost by treatment for linezolid and vancomycin therapy in Beijing, Guangzhou, Nanjing, and Xi’an, the People’s Republic of China.

Note: Courtesy of Wan et al.⁹

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