What Is the Best Therapeutic Approach to MRSA Pneumonia?
What Is the Best Therapeutic Approach to MRSA Pneumonia?
Purpose of review The purpose of this review is to define what the best therapeutic approach is for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.
Recent findings Although two meta-analyses reported conflicting findings, recent retrospective studies reported higher success rates in patients with MRSA pneumonia treated with linezolid when compared to vancomycin. Only registration trials are available for some anti-MRSA antibiotics, such as telavancin, ceftaroline, and ceftobiprole. Scarce information is available regarding the best therapeutic approach for MRSA community-acquired pneumonia.
Summary Linezolid seems to be a better choice than vancomycin for the treatment of MRSA ventilator-associated pneumonia. It is still unclear whether this affirmation holds for other forms of MRSA pneumonia. Further research is needed to define whether newer antibiotics are better alternatives than currently recommended agents.
Pneumonia remains an important cause of morbidity and mortality worldwide. Along with influenza, they constitute the eighth leading cause of death in the United States. Appropriate initial antibiotic therapy is critical in order to achieve good outcomes. If empiric antibiotics do not cover the etiologic agent(s), adjusting therapy once the cause is known does not improve clinical outcomes.
Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen that can be the etiologic agent of pneumonia occurring in any setting. Although several antibiotics are available for the treatment of infections due to MRSA, just a few have been approved so far for the treatment of pneumonia. Vancomycin has been the standard of care for over 50 years but the difficulty in reaching appropriate serum levels and more recent data reporting worse outcomes with higher MRSA minimum inhibitory concentrations (MICs) has pushed the search for other options. Linezolid, telavancin, ceftaroline, and ceftobiprole are antibiotics available in the market for the treatment of MRSA pneumonia. Tedizolid, dalbavancin, and oritavancin are currently being evaluated for the treatment of other infections apart from skin and soft tissue structures infection.
For the management of healthcare-associated pneumonia (HCAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP), the American Thoracic Society (ATS) and the Infectious Disease Society of America (IDSA) guidelines recommended either vancomycin or linezolid for the coverage of MRSA. These guidelines mentioned, however, that, although further investigation was needed, linezolid could be a better choice for MRSA VAP under certain circumstances. During the last 2 years, a few more articles were published comparing vancomycin and linezolid with conflicting results. Newer antibiotics have also been evaluated with scarcer information regarding the best therapeutic option to treat pneumonia due to MRSA.
Much less has been published in the area of community-acquired pneumonia (CAP) due to MRSA, in part related to the low prevalence of MRSA as the etiologic agent of CAP (approximately 2%). Nevertheless, community-associated MRSA seems to produce more severe pneumonia with increased mortality when compare to its hospital-acquired counterpart or even other organisms, and thus empiric coverage becomes critical.
Despite published data and years of experience using some of these antibiotics, it is still not clear what the best therapeutic approach is for the treatment of pneumonia due to MRSA.
In this article, the authors will discuss the following points:
Abstract and Introduction
Abstract
Purpose of review The purpose of this review is to define what the best therapeutic approach is for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.
Recent findings Although two meta-analyses reported conflicting findings, recent retrospective studies reported higher success rates in patients with MRSA pneumonia treated with linezolid when compared to vancomycin. Only registration trials are available for some anti-MRSA antibiotics, such as telavancin, ceftaroline, and ceftobiprole. Scarce information is available regarding the best therapeutic approach for MRSA community-acquired pneumonia.
Summary Linezolid seems to be a better choice than vancomycin for the treatment of MRSA ventilator-associated pneumonia. It is still unclear whether this affirmation holds for other forms of MRSA pneumonia. Further research is needed to define whether newer antibiotics are better alternatives than currently recommended agents.
Introduction
Pneumonia remains an important cause of morbidity and mortality worldwide. Along with influenza, they constitute the eighth leading cause of death in the United States. Appropriate initial antibiotic therapy is critical in order to achieve good outcomes. If empiric antibiotics do not cover the etiologic agent(s), adjusting therapy once the cause is known does not improve clinical outcomes.
Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen that can be the etiologic agent of pneumonia occurring in any setting. Although several antibiotics are available for the treatment of infections due to MRSA, just a few have been approved so far for the treatment of pneumonia. Vancomycin has been the standard of care for over 50 years but the difficulty in reaching appropriate serum levels and more recent data reporting worse outcomes with higher MRSA minimum inhibitory concentrations (MICs) has pushed the search for other options. Linezolid, telavancin, ceftaroline, and ceftobiprole are antibiotics available in the market for the treatment of MRSA pneumonia. Tedizolid, dalbavancin, and oritavancin are currently being evaluated for the treatment of other infections apart from skin and soft tissue structures infection.
For the management of healthcare-associated pneumonia (HCAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP), the American Thoracic Society (ATS) and the Infectious Disease Society of America (IDSA) guidelines recommended either vancomycin or linezolid for the coverage of MRSA. These guidelines mentioned, however, that, although further investigation was needed, linezolid could be a better choice for MRSA VAP under certain circumstances. During the last 2 years, a few more articles were published comparing vancomycin and linezolid with conflicting results. Newer antibiotics have also been evaluated with scarcer information regarding the best therapeutic option to treat pneumonia due to MRSA.
Much less has been published in the area of community-acquired pneumonia (CAP) due to MRSA, in part related to the low prevalence of MRSA as the etiologic agent of CAP (approximately 2%). Nevertheless, community-associated MRSA seems to produce more severe pneumonia with increased mortality when compare to its hospital-acquired counterpart or even other organisms, and thus empiric coverage becomes critical.
Despite published data and years of experience using some of these antibiotics, it is still not clear what the best therapeutic approach is for the treatment of pneumonia due to MRSA.
In this article, the authors will discuss the following points:
Characteristics of antibiotics with activity against MRSA.
Recent evidence (within the last 12–18 months) for therapeutic approaches to treat MRSA pneumonia, focusing particularly on VAP and, to a lesser degree, on CAP.
Best therapeutic approach for the treatment of MRSA VAP.
Best therapeutic approach for the treatment of MRSA CAP.
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