Diabetic MRSA foot infection — role of linezolid therapy

Abstract

D iabetic foot ulceration is common and disabling, often leading to amputation of the leg. Foot ulcers commonly become infected and MRSA infection is becoming more prevalent. MRSA is becoming a major public health problem because of its associated high morbidity and mortality, due to difficulty in its eradication with conventional antibiotics. Although vancomycin is the present mainstay of treatment of MRSA infection, a recently introduced antibiotic, linezolid may have benefits. Linezolid can be given orally, obviating the need for i.v. monitoring and offering potential savings in hospital costs with earlier discharge because of its suitability for out-patient eradication of MRSA. Br J Diabetes Vasc Dis 2004;4:44-6

Co-Therapy Using Lytic Bacteriophage and Linezolid: Effective Treatment in Eliminating Methicillin Resistant Staphylococcus aureus (MRSA) from Diabetic Foot Infections

“…The prevalence of MRSA in infected foot ulcers is as high as 30% and an increase has been noticed in its incidence in many countries [5]. A recent study from Manchester has reported MRSA isolation in 30.2% of patients, which is a 100% increase as compared to three years earlier [6]. Also MRSA bacteremia in diabetics with foot infections is associated with 43% mortality compared to 20% mortality rate reported with methicillin sensitive S.aureus (MSSA) bacteremia [7] The mortality rate is much higher in case of diabetic foot infections caused by MRSA undergoing amputation (43% MRSA vs 9% non-MRSA) [8].…”

“…Linezolid is a suitable alternative because it has 100% oral bioavailability which allows conversion from intravenous to oral therapies as soon as the patient is clinically stable, thus allowing early discharge and reduced economic burden on the patient. This provides an advantage over comparative therapy (vancomycin and quinupristin/dalfopristin) which can only be delivered parenterally [6].…”

Mortality rates in hospital patients with hyperglycaemia and MRSA bacteraemia

“…Linezolid also offers potential savings in hospital costs due to earlier patient discharge. 9 There is the need to consider carefully what, and how, economic evaluation should be conducted in the area of antimicrobial resistance. 10 Glucose is only detectable in airway secretions when patients become hyperglycaemic (> 9.7 mmol/L) and a recent study showed that the presence of glucose in bronchial aspirates of intubated patients increased the risk of colonisation or infection with pathogenic bacteria, including respiratory MRSA which resulted in a longer (p<0.01) stay in the intensive care unit.…”

Resistensi Terhadap Methicillin (Methicillin Resistant) Staphylococcus Aureus Di Instalasi Rawat Inap

“…2 MRSA merupakan bentuk patogen utama akibat perawatan (nosokomial) di seluruh dunia dan menjadi masalah yang paling mendesak. 3,4 Centers for Disease Control and Prevention (CDC) pada tahun 2007 melaporkan bahwa di Amerika Serikat terjadi peningkatan dua kali lipat jumlah infeksi MRSA, dari 127.000 kasus tahun 1999 menjadi 278.000 tahun 2005 dan waktu yang sama terjadi peningkatan angka kematian (mortalitas) dari 11.000 menjadi lebih dari 17.000. Di Indonesia, jumlah penyakit tertentu (prevalensinya) pada tahun 2006 berkisar 23,5%.…”

“…Mungkin MRSA merupakan patogen yang sering menyebabkan infeksi di rumah sakit, sehingga rawat inap lebih lama dan biaya yang lebih tinggi untuk pengobatan dan persyaratan pengendalian infeksi. 4 Pasien yang terinfeksi MRSA terbanyak dirawat di ruang perawatan: bedah ortopedik (30%), penyakit dalam 22%, penyakit anak dan perinatal 19%, bedah (bedah saraf dan urologik) 18% penyakit kulit kelamin 7% dan ICU 4%. Hasil meneliti ini sesuai dengan pengelompokan (klasifikasi) Royal College of Nursing (RCN) yang membagi daerah kebahayaan (area risiko) klinis menjadi empat (4) golongan (kategori) yaitu berkebahayaan: tinggi, sedang, rendah dan tersedikit yaitu ruang perawatan ortopedik, unit perawatan bayi dan ICU termasuk dalam golongan daerah berkebahayaan (kategori area risiko) tinggi infeksi MRSA.…”