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Author: Admin | 2025-04-28
MRSA infection, or all-cause mortality). Before patients were discharged from the hospital to complete their respective outpatient therapies, MRSA BSI clearance was mandatory. The most common oral therapy was linezolid (50%), followed by trimethoprim/sulfamethoxazole (34%) and clindamycin (15.7%). The difference in 90-day failure was not significant in the oral-therapy group compared with the IV group (hazard ratio [HR] 0.379, 95% CI, 0.131-1.101) and patients in the oral group had a reduced rate of 90-day hospital readmission (HR 0.603, 95% CI, 0.388-0.937). Willekens et al compared an early switch to linezolid between Days 3 and 9 of treatment to full standard parenteral therapy in a prospective study of 135 patients with uncomplicated MRSA BSI.15 There was no difference found in 90-day relapse between the two groups nor in 30-day all-cause mortality. In addition, the median length of hospital stay was significantly shorter in the linezolid group versus the standard parental therapy group (8 vs. 19 days, P Evidence found in these studies support the safety and efficacy of transitioning a patient with uncomplicated MRSA BSI from IV to oral therapy for the remaining duration of treatment in order to decrease hospital length of stay and healthcare costs while achieving the same outcome. To emphasize, it is important that only uncomplicated infections be considered for oral antibiotics, and infective endocarditis must be ruled out when treating Gram-positive BSI.14 Oral linezolid and trimethoprim/sulfamethoxazole have favorable pharmacokinetics with 100% bioavailability, and a 2005 pooled analysis demonstrated noninferiority of linezolid to vancomycin for S aureus BSI.16 Other agents with activity against MRSA, such as clindamycin and doxycycline, have limited data in treating BSI, and the 2011 IDSA guidelines advise against their use in this setting.14Enterococcus Species: Another important cause of Gram-positive BSI is Enterococcus species, specifically E faecalis and E faecium.17 Currently, there is a
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