European perspective and update on the management of nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus after more than 10 years of experience with linezolid

Clin Microbiol Infect. 2014 Apr:20 Suppl 4:19-36. doi: 10.1111/1469-0691.12450.


Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of antimicrobial-resistant hospital-acquired infections worldwide and remains a public health priority in Europe. Nosocomial pneumonia (NP) involving MRSA often affects patients in intensive care units with substantial morbidity, mortality and associated costs. A guideline-based approach to empirical treatment with an antibacterial agent active against MRSA can improve the outcome of patients with MRSA NP, including those with ventilator-associated pneumonia. New methods may allow more rapid or sensitive diagnosis of NP or microbiological confirmation in patients with MRSA NP, allowing early de-escalation of treatment once the pathogen is known. In Europe, available antibacterial agents for the treatment of MRSA NP include the glycopeptides (vancomycin and teicoplanin) and linezolid (available as an intravenous or oral treatment). Vancomycin has remained a standard of care in many European hospitals; however, there is evidence that it may be a suboptimal therapeutic option in critically ill patients with NP because of concerns about its limited intrapulmonary penetration, increased nephrotoxicity with higher doses, as well as the emergence of resistant strains that may result in increased clinical failure. Linezolid has demonstrated high penetration into the epithelial lining fluid of patients with ventilator-associated pneumonia and shown statistically superior clinical efficacy versus vancomycin in the treatment of MRSA NP in a phase IV, randomized, controlled study. This review focuses on the disease burden and clinical management of MRSA NP, and the use of linezolid after more than 10 years of clinical experience.

Keywords: Clinical management; Europe; linezolid; methicillin-resistant Staphylococcus aureus; nosocomial pneumonia; ventilator-associated pneumonia.

Publication types

  • Review

MeSH terms

  • Acetamides / pharmacokinetics
  • Acetamides / therapeutic use*
  • Animals
  • Anti-Bacterial Agents / pharmacokinetics
  • Anti-Bacterial Agents / therapeutic use*
  • Cross Infection / diagnosis
  • Cross Infection / drug therapy
  • Cross Infection / economics
  • Cross Infection / epidemiology
  • Cross Infection / microbiology
  • Disease Models, Animal
  • Europe
  • Humans
  • Linezolid
  • Methicillin-Resistant Staphylococcus aureus*
  • Oxazolidinones / pharmacokinetics
  • Oxazolidinones / therapeutic use*
  • Pneumonia, Staphylococcal / diagnosis
  • Pneumonia, Staphylococcal / drug therapy*
  • Pneumonia, Staphylococcal / economics
  • Pneumonia, Staphylococcal / epidemiology
  • Pneumonia, Staphylococcal / microbiology
  • Pneumonia, Ventilator-Associated / mortality
  • Practice Guidelines as Topic
  • Risk Factors
  • Vancomycin / therapeutic use


  • Acetamides
  • Anti-Bacterial Agents
  • Oxazolidinones
  • Vancomycin
  • Linezolid