Infect Chemother.  2014 Sep;46(3):172-181. 10.3947/ic.2014.46.3.172.

Oral Antimicrobial Therapy: Efficacy and Safety for Methicillin-Resistant Staphylococcus aureus Infections and Its Impact on the Length of Hospital Stay

Affiliations
  • 1Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 2Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. hbkimmd@snu.ac.kr
  • 3Division of Infectious Diseases, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.
  • 4Division of Infectious Diseases, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea.
  • 5Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
  • 6Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Medical Center, Seoul, Korea.
  • 7Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea.

Abstract

BACKGROUND
Carefully switching from intravenous to oral antibiotic therapy has shown to reduce treatment costs and lengths of hospital stay as well as increase safety and comfort in patients with infections. The aim of this study was to compare the clinical efficacy and safety between the patients treated with glycopeptides (case group), and the patients given oral antibiotics, as the initial or step-down therapy (control group), in the treatment of patients with methicillin-resistant Staphylococcus aureus (MRSA) infection.
MATERIALS AND METHODS
A multicenter observational study was retrospectively performed in 7 teaching hospitals in Korea from January to December 2012. The study included adult patients (> or = 18 years) with infection caused by MRSA isolates, susceptible to clindamycin, erythromycin, and ciprofloxacin. The primary end point was treatment outcome, including all-cause mortality and switching of antibiotics. Drug-related adverse events and the lengths of hospital stay were also compared between the two treatment groups.
RESULTS
During the study period, 107 patients (43 cases and 64 controls) with MRSA infections were enrolled from the participating hospitals. The most common sites of MRSA infection were skin and soft tissue (n = 28) and bone and joint (n = 26). The median Charlson comorbidity index (P = 0. 560), the frequency of severe sepsis (P = 0.682) or thrombocytopenia (P = 1.000), and median level of serum C-reactive protein (P = 0.157) at the onset of MRSA infections were not significantly different between the case and control groups. The oral antibiotics most frequently prescribed in the case group, were fluoroquinolones (n = 29) and clindamycin (n = 8). The median duration of antibiotic treatment (P = 0.090) and the occurrence of drug-related adverse events (P = 0.460) did not reach statistically significant difference between the two groups, whereas the total length of hospital stay after the onset of MRSA infection was significantly shorter in the case group than the control group [median (interquartile range), 23 days (8-41) vs. 32 days (15-54), P = 0.017]. In multivariate analyses, the type of antibiotic used was not an independent risk factor for treatment failure. The statistically significant factors associated with treatment failure included underlying hepatic diseases, prior receipt of antibiotics, and foreign body retention.
CONCLUSIONS
This study indicates that oral antibiotic therapy with active agents against MRSA isolates can be considered as the initial or step-down therapy for the treatment of MRSA infections and also reduce the length of hospital stay.

Keyword

Methicillin-resistant Staphylococcus aureus; Administration; Oral; Length of stay

MeSH Terms

Adult
Anti-Bacterial Agents
C-Reactive Protein
Ciprofloxacin
Clindamycin
Comorbidity
Erythromycin
Fluoroquinolones
Foreign Bodies
Glycopeptides
Health Care Costs
Hospitals, Teaching
Humans
Joints
Korea
Length of Stay*
Methicillin-Resistant Staphylococcus aureus*
Mortality
Multivariate Analysis
Observational Study
Retrospective Studies
Risk Factors
Sepsis
Skin
Thrombocytopenia
Treatment Failure
Treatment Outcome
Anti-Bacterial Agents
C-Reactive Protein
Ciprofloxacin
Clindamycin
Erythromycin
Fluoroquinolones
Glycopeptides

Reference

1. Kim ES, Song JS, Lee HJ, Choe PG, Park KH, Cho JH, Park WB, Kim SH, Bang JH, Kim DM, Park KU, Shin S, Lee MS, Choi HJ, Kim NJ, Kim EC, Oh MD, Kim HB, Choe KW. A survey of community-associated methicillin-resistant Staphylococcus aureus in Korea. J Antimicrob Chemother. 2007; 60:1108–1114.
Article
2. Park SH, Park C, Yoo JH, Choi SM, Choi JH, Shin HH, Lee DG, Lee S, Kim J, Choi SE, Kwon YM, Shin WS. Emergence of community-associated methicillin-resistant Staphylococcus aureus strains as a cause of healthcare-associated bloodstream infections in Korea. Infect Control Hosp Epidemiol. 2009; 30:146–155.
Article
3. Charlebois ED, Perdreau-Remington F, Kreiswirth B, Bangsberg DR, Ciccarone D, Diep BA, Ng VL, Chansky K, Edlin BR, Chambers HF. Origins of community strains of methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2004; 39:47–54.
Article
4. Almer LS, Shortridge VD, Nilius AM, Beyer JM, Soni NB, Bui MH, Stone GG, Flamm RK. Antimicrobial susceptibility and molecular characterization of community-acquired methicillin-resistant Staphylococcus aureus. Diagn Microbiol Infect Dis. 2002; 43:225–232.
Article
5. Khawcharoenporn T, Alan T. Oral antibiotic treatment for methicillin-resistant Staphylococcus aureus skin and soft tissue infections: review of the literature. Hawaii Med J. 2006; 65:290–293.
6. Enoch DA, Karas JA, Aliyu SH. Oral antimicrobial options for the treatment of skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in the UK. Int J Antimicrob Agents. 2009; 33:497–502.
Article
7. Barnes EV 2nd, Dooley DP, Hepburn MJ, Baum SE. Outcomes of community-acquired, methicillin-resistant Staphylococcus aureus, soft tissue infections treated with antibiotics other than vancomycin. Mil Med. 2006; 171:504–507.
Article
8. Mathews CJ, Weston VC, Jones A, Field M, Coakley G. Bacterial septic arthritis in adults. Lancet. 2010; 375:846–855.
Article
9. Lew DP, Waldvogel FA. Osteomyelitis. Lancet. 2004; 364:369–379.
Article
10. Sabol KE, Echevarria KL, Lewis JS 2nd. Community-associated methicillin-resistant Staphylococcus aureus: new bug, old drugs. Ann Pharmacother. 2006; 40:1125–1133.
Article
11. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004; 351:1645–1654.
Article
12. Dryden M, Saeed K, Townsend R, Winnard C, Bourne S, Parker N, Coia J, Jones B, Lawson W, Wade P, Howard P, Marshall S. Antibiotic stewardship and early discharge from hospital: impact of a structured approach to antimicrobial management. J Antimicrob Chemother. 2012; 67:2289–2296.
Article
13. Nathwani D, Eckmann C, Lawson W, Stephens JM, Macahilig C, Solem CT, Simoneau D, Chambers R, Li JZ, Haider S. Pan-European early switch/early discharge opportunities exist for hospitalised patients with methicillin-resistant Staphylococcus aureus complicated skin and soft-tissue infections. Clin Microbiol Infect. 2014; 03. 27. [Epub ahead of print].
14. Daver NG, Shelburne SA, Atmar RL, Giordano TP, Stager CE, Reitman CA, White AC Jr. Oral step-down therapy is comparable to intravenous therapy for Staphylococcus aureus osteomyelitis. J Infect. 2007; 54:539–544.
Article
15. Itani KM, Biswas P, Reisman A, Bhattacharyya H, Baruch AM. Clinical efficacy of oral linezolid compared with intravenous vancomycin for the treatment of methicillin-resistant Staphylococcus aureus-complicated skin and soft tissue infections: a retrospective, propensity score-matched, case-control analysis. Clin Ther. 2012; 34:1667–1673.
16. O'Brien FG, Lim TT, Chong FN, Coombs GW, Enright MC, Robinson DA, Monk A, Saïd-Salim B, Kreiswirth BN, Grubb WB. Diversity among community isolates of methicillin-resistant Staphylococcus aureus in Australia. J Clin Microbiol. 2004; 42:3185–3190.
17. David MZ, Glikman D, Crawford SE, Peng J, King KJ, Hostetler MA, Boyle-Vavra S, Daum RS. What is community-associated methicillin-resistant Staphylococcus aureus? J Infect Dis. 2008; 197:1235–1243.
Article
18. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988; 16:128–140.
Article
19. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994; 47:1245–1251.
Article
20. Longo DL, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrison's principles of internal medicine. 18th ed. New York: McGraw-Hill;2012.
21. Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, Talan DA. EMERGEncy ID Net Study Group. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006; 355:666–674.
Article
22. Francis JS, Doherty MC, Lopatin U, Johnston CP, Sinha G, Ross T, Cai M, Hansel NN, Perl T, Ticehurst JR, Carroll K, Thomas DL, Nuermberger E, Bartlett JG. Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes. Clin Infect Dis. 2005; 40:100–107.
Article
23. Ko J, Chung DR, Park SY, Baek JY, Kim SH, Kang CI, Peck KR, Lee NY, Song JH. First imported case of skin infection caused by PVL-positive ST30 community-associated methicillin-resistant Staphylococcus aureus clone in a returning Korean traveler from the Philippines. J Korean Med Sci. 2013; 28:1100–1102.
Article
24. Joo EJ, Chung DR, Ha YE, Park SY, Kang SJ, Kim SH, Kang CI, Peck KR, Lee NY, Ko KS, Song JH. Community-associated Panton-Valentine leukocidin-negative methicillin-resistant Staphylococcus aureus clone (ST72-MRSA-IV) causing healthcare-associated pneumonia and surgical site infection in Korea. J Hosp Infect. 2012; 81:149–155.
Article
25. Kaka AS, Rueda AM, Shelburne SA 3rd, Hulten K, Hamill RJ, Musher DM. Bactericidal activity of orally available agents against methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother. 2006; 58:680–683.
Article
26. Markowitz N, Quinn EL, Saravolatz LD. Trimethoprim-sulfamethoxazole compared with vancomycin for the treatment of Staphylococcus aureus infection. Ann Intern Med. 1992; 117:390–398.
Article
27. Chen LF, Chastain C, Anderson DJ. Community-acquired methicillin-resistant Staphylococcus aureus skin and soft tissue infections: management and prevention. Curr Infect Dis Rep. 2011; 13:442–450.
Article
28. DeLeo FR, Otto M, Kreiswirth BN, Chambers HF. Community-associated methicillin-resistant Staphylococcus aureus. Lancet. 2010; 375:1557–1568.
29. Kim BN, Kim ES, Oh MD. Oral antibiotic treatment of staphylococcal bone and joint infections in adults. J Antimicrob Chemother. 2014; 69:309–322.
Article
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