The Impact of Empiric Linezolid Compared With Vancomycin on Inpatient Outcomes

Background: Vancomycin and linezolid are commonly used for empiric treatment of methicillin-resistant Staphylococcus aureus (MRSA), but differences may influence the preferred agent. Vancomycin requires individualized dosing and drug monitoring, possibly delaying initiation. Linezolid offers fixed dosing, and potentially lower costs, which may improve time to first dose. This study compares clinical, operational, and cost outcomes associated with empiric vancomycin and linezolid use. Methods: This single-center, retrospective chart review included a convenience sample of 100 hospitalized adults receiving more than 1 dose of empiric vancomycin or linezolid, stratified by level of care (intensive care unit [ICU] vs non-ICU). The primary endpoint was 30-day all-cause mortality. Secondary endpoints included time to first dose, adverse events, therapy changes, treatment duration, length of stay (LOS), cost, and vancomycin dosing characteristics. Results: A convenience sample of 100 patients (50 per group) was analyzed. Thirty-day all-cause mortality was 22% with vancomycin versus 12% with linezolid ( P = .183). No statistically significant differences were observed in time to first dose (2.03 ± 1.51 hours vs 1.6 ± 1.66 hours, P = .180). No statistically significant difference was detected in therapy changes, treatment duration, hospital/ICU LOS, treatment failure, and adverse events. Vancomycin had a higher medication cost ($46.59 vs $29.52, P = .012). Patients receiving vancomycin had an average of 2.8 levels, requiring a median of 54.6 hours to reach therapeutic range, maintaining it for 29.5% of treatment duration. This study is limited by its retrospective design and small sample size. Conclusion: No statistically significant differences in clinical outcomes were detected between patients receiving empiric linezolid and vancomycin. Linezolid was associated with lower drug acquisition cost.