Today’s Shennei consultation said that a patient with aureus wants to use linezolid.
After reading the sputum culture, I found that it was MSSA, so I decided to use a first-generation cephalosporin.
But Director Bo said: The patient’s sputum culture is also sensitive to linen, so it’s more reassuring to use linen.
I’m also a little dizzy. What he said is right. Many of our MRSA patients are using Lina very well. Even compared with the first choice, I prefer Lina.
If the priority order of the guideline is not considered, will the application of high-end antibiotics such as Vancure and Linais for an MSSA be better than the low-end first-generation cephalosporins and penicillins?
This is a really interesting question.
I searched the literature and found that there is such a study.
“2011 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Treatment of MRSA Infections” clearly pointed out that β-lactams are clearly superior to vancomycin in the treatment of MSSA-BSI and MSSA infective endocarditis White.
2015 Spanish Society of Infectious Diseases and Society of Clinical Microbiology “Guidelines for Staphylococcus aureus Bloodstream Infection and Endocarditis” recommends: Cloxacillin (BI) for simple MSSA bloodstream infection and complex bloodstream infection Choose cloxacillin, 2 grams every 4 hours, or continuous infusion (AI).
2020 “Principles and Practices of Infectious Diseases” (PPID), 9th Edition Recommendations: Enzyme-resistant penicillin (ASP: oxacillin, cloxacillin, etc.) or first-generation cephalosporins is the first choice for MSSA infection.
A retrospective cohort study published in Clinical Infectious Diseases in 2015. The study included patients with MSSA bloodstream infection in 122 hospitals between 2003 and 2010, who were treated with beta-lactam antibiotics (including nafcillin, Patients treated with lacillin/tazobactam, ceftriaxone, and oxacillin, etc.) or vancomycin had a 35% reduction in 30-day all-cause mortality compared with the latter, and a 43% reduction in the risk of death.
For MSSA infections, especially bloodstream infections, β-lactam antibiotics are still the first-line recommendation. The tissue concentration of linezolid is its biggest advantage, but its bloodstream concentration is its weakness. Perhaps for MSSA infections that are not mainly bloodstream infections, the use of linezolid will have its own therapeutic advantages.