ABSTRACT
Panton-Valentine leukocidin (PVL)-positive USA300 clone has been the most successful community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clone spreading in North America. In contrast, PVL-negative ST72-CA-MRSA has been predominant in Korea, and there has been no report of infections by the USA300 strain except only one case report of perianal infection. Here, we describe the first case of pneumonia caused by the USA300 strain following pandemic influenza A (H1N1) in Korea. A 50-year-old man was admitted with fever and cough and chest radiograph showed pneumonic consolidation at the right lower lung zone. He received a ventilator support because of respiratory failure. PCR for pandemic influenza A (H1N1) in nasopharyngeal swab was positive, and culture of sputum and endotracheal aspirate grew MRSA. Typing of the isolate revealed that it was PVL-positive, ST 8-MRSA-SCCmec type IV. The analysis of the PFGE patterns showed that this isolate was the same pulsotype as the USA300 strain.
Subject(s)
Humans , Male , Middle Aged , Community-Acquired Infections/etiology , Influenza A Virus, H1N1 Subtype , Influenza, Human/complications , Methicillin-Resistant Staphylococcus aureus/classification , Pneumonia, Staphylococcal/etiology , Republic of Korea , Staphylococcal Infections/etiologyABSTRACT
Linezolid, an oxazolidinone-class antimicrobial agent, is a new drug; its use has frequently been questioned due to its high price. However, recent trials have demonstrated that the use of linezolid in mechanical ventilation-associated nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (VAP-MRSA) may be justified due to its improved efficacy compared to vancomycin. Price and cost have different magnitudes, and clinical efficacy should always be considered in the decision-making process. Our objective was to determine whether linezolid treatment was more cost-effective than vancomycin for treating VAP-MRSA. METHODOLOGY: Elaboration of an economic model from a metanalysis of previous clinical trials comparing both drugs, through a cost-effectiveness analysis. Costs of the treatments were calculated using Brazilian parameters and were compared to the results obtained in the metanalysis. In order to compare the results with real life conditions, costs were calculated for both name brand and for generic vancomycin. RESULTS: The cost (May/2004) per unit (vial, ampoule or bag) was R$ 47.73 for the name-brand vancomycin, R$ 14.45 for generic vancomycin and R$ 214.04 for linezolid. Linezolid's efficacy in VAP-MRSA according to the metanalysis was 62.2 percent and vancomycin's efficacy was 21.2 percent. The total cost per cured patient was R$ 13,231.65 for the name-brand vancomycin, R$ 11,277.59 for generic vancomycin and R$ 7,764.72 for linezolid. CONCLUSION: Despite the higher price per unit, linezolid was more cost-effective than vancomycin.
Subject(s)
Humans , Acetamides/therapeutic use , Anti-Bacterial Agents/therapeutic use , Cross Infection/drug therapy , Oxazolidinones/therapeutic use , Pneumonia, Staphylococcal/drug therapy , Vancomycin/therapeutic use , Acetamides/economics , Anti-Bacterial Agents/economics , Cost-Benefit Analysis , Cross Infection/economics , Cross Infection/etiology , Drug Costs , Methicillin Resistance/drug effects , Oxazolidinones/economics , Pneumonia, Staphylococcal/economics , Pneumonia, Staphylococcal/etiology , Respiration, Artificial/adverse effects , Staphylococcus aureus , Vancomycin/economicsABSTRACT
Analizamos 101 casos de neumonia adquirida en la comunidad, en pacientes con patologia de riesgo atendidos en el CMQBB los ultimos 10 anos. Se deseaba conocer el aporte de los procedimientos de busqueda etiologica, correlacionar los patrones radiograficos pulmonares con los microbiologicos,analizar las patologias subyacentes y catalogar la evolucion del cuadro. Constatamos el agente etiologico en 76 pacientes, resultando positivas 40/60 muestras de espectoracion, 15/24 hemocultivos, 10/16 muestras de liquido pleural, 8/9 aspirados bronquiales, 4/4 aspirados broncofibroscopicos y 2/2 muestras quirurgicas. Se identifico mas frecuentemente el neumococo, los gram negativos y el estafilococo en 28, 23 y 15 pacientes respectivamente. La correlacion clinico-radiologica como hipotesis inicial de diagnostico histologico fue valida en 59 casos. De los 50 pacientes con neumopatias cronicas, 28 tenian EPOC, la insuficiencia respiratoria estuvo asociada en 35 pacientes. evolucionaron favorablemente 74 pacientes, 16 presentaron complicaciones, estableciendose insuficiencia respiratoria y cavitacion pulmonar en 8 casos cada una. Fallecieron 11 pacientes constatandose septicemia aislada o asociada en 7 de ellos. En conclusion, el diagnostico etiologico precoz, tratamiento especifico y la atencion eficaz de las patologias de riesgoasociadas determinan menor morbimortalidad por neumonia