OBJECTIVES: To evaluate the safety and efficacy of vancomycin with the other anti-Gram-positive bacteria antibiotics in the treatment of Staphylococcus aureus bacteraemia.
METHODS: We searched the PubMed, MEDLINE, Embase and Cochrane Library databases until August 2022 for studies that compared vancomycin with other antibiotic regimens for treating Staphylococcus aureus bacteraemia. Clinical and microbiological responses, adverse events, relapse rate and mortality were considered.
RESULTS: Fifteen randomized controlled trials and nine retrospective studies were included. The efficacy and safety data of vancomycin differed from those of the comparators group. After subgroup analysis, the differences came mainly from the trials compared with daptomycin. Compared to daptomycin, vancomycin showed a lower microbiological cure rate (OR = 0.58, 95% CI = 0.41∼0.82, I2 = 0%, P = 0.002) and clinical cure rate (OR = 0.53, 95% CI = 0.42∼0.68, I2 = 3%, P < 0.00001), as well as more adverse events (OR = 3.21, 95% CI = 1.43∼7.19, I2 = 59%, P = 0.005).
CONCLUSION: The efficacy of vancomycin in treating Staphylococcus aureus bacteraemia is still excellent but slightly inferior in adverse events. However, this does not affect its use as a first-line drug. Daptomycin is expected to be a better antimicrobial drug.
BACKGROUND: This systematic review and meta-analysis aimed to investigate the clinical efficacy and safety of novel lipoglycopeptides in treating acute bacterial skin and skin structure infections (ABSSSIs).
RESEARCH DESIGN AND METHODS: PubMed, Embase, Cochrane Central Register of Controlled Trials, Turning Research into Practice, and ClinicalTrials.gov were searched from inception to 20 May 2021. Randomized controlled trials (RCTs) comparing the clinical efficacy and safety of lipoglycopeptides with other comparators in treating adult patients with ABSSSIs were included. The primary outcome was clinical response.
RESULTS: Eight RCTs (6416 patients; lipoglycopeptides: 3359, comparators: 3057) were enrolled. Clinical response rate was not significantly different between lipoglycopeptides and comparators at early-clinical-evaluation (odds ratio [95% confidence interval]: 1.01 [0.85-1.20], I2 = 34%), end-of-treatment (0.94 [0.80-1.11], I2 = 0%), and test-of-cure (1.05 [0.85-1.30], I2 = 0%). Lipoglycopeptides showed a similar overall microbiological eradication rate (1.12 [0.90-1.38], I2 = 21%) but a borderline higher microbiological eradication rate for methicillin-resistant Staphylococcus aureus (1.37 [1.00-1.86], I2 = 0%) than the comparators. Lipoglycopeptides were not associated with a higher risk than comparators.
CONCLUSIONS: Lipoglycopeptides can achieve similar clinical and microbiological responses to other comparators in treating ABSSSIs. In addition, lipoglycopeptides are as tolerable as their comparators.
INTRODUCTION: Skin and soft structure infections (SSTIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) pose serious health risks and cause significant cost burdens, and a conclusive recommendation about antibiotics has not yet been generated. Therefore, we performed this updated network meta-analysis to determine the preferred drug for the treatment of MRSA-caused SSTIs.
METHODS: We searched PubMed, Embase, and Cochrane Library to identify any potentially eligible randomized controlled trials (RCTs) investigating the comparative efficacy and safety of any two of vancomycin, linezolid, tedizolid, and daptomycin in MRSA-caused SSTIs. All statistical analyses were conducted with RevMan, ADDIS, and STATA software.
RESULTS: Twenty eligible RCTs involving 7804 patients were included for the final analysis. Direct meta-analysis suggested that linezolid was superior to vancomycin in improving clinical (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.07-1.99; P = 0.02) and microbiological (OR, 1.89; 95% CI, 1.24-2.86; P = 0.003) success, which were all confirmed by network meta-analyses. No statistical differences were identified regarding other comparisons. Meanwhile, there were no significant differences between any two antibiotics related to safety. Moreover, ranking probabilities indicated that linezolid had the highest probability of being ranked best in terms of clinical and microbiological success.
CONCLUSION: Based on the limited evidence, linezolid may be a preferred antibiotic for the treatment of MRSA-caused SSTIs because it showed superiority in clinical and microbiological success without difference regarding safety.
OBJECTIVE: To compare between current evidence of novel glycopeptides against vancomycin for the treatment of gram-positive bacterial infections.
METHODOLOGY: A systematic review and meta-analysis was done. Major databases were searched for eligible randomized control trials that assessed clinical success, microbiological success and safety profile of novel glycopeptides versus vancomycin for infections caused by gram-positive bacteria.
RESULTS: This meta-analysis included eleven trials (7289 participants) comparing telavancin, dalbavancin and oritavancin with vancomycin. No differences were detected between novel glycopeptides and vancomycin for the treatment of skin and soft tissue infections (SSTIs) among modified intent-to-treat patients (OR: 1.04, CI: 0.92-1.17) as well as within the clinically evaluable patients (OR: 1.09, CI: 0.91-1.30). Data analysed from SSTIs, HAP and bacteremia studies on telavancin showed insignificant high clinical response in microbiologically evaluable patients infected with methicillin resistant Staphylococcus aureus (MRSA) (OR: 1.57, CI: 0.94-2.62, p: 0.08) and in the eradication of MRSA (OR: 1.39, CI: 0.99-1.96, P:0.06). Dalbavancin was non-inferior to vancomycin for the treatment of osteomyelitis in a phase II trial, while it was superior to vancomycin for the treatment of bacteremia in a phase II trial. Data analysed from all trials showed similar rates of all-cause mortality between compared antibiotics groups (OR: 0.67, CI: 0.11-4.03). Telavancin was significantly related with higher adverse events (OR: 1.24, CI: 1.07-1.44, P: <0.01) while dalbavancin and oritavancin were associated with significant fewer adverse events (OR: 0.73, CI: 0.57-0.94, p: 0.01; OR: 0.72, CI: 0.59-0.89, p: <0.01 respectively).
CONCLUSION: Efficacy and safety profiles of both dalbavancin and oritavancin were the same as vancomycin in the treatment of gram-positive bacterial infections in different clinical settings, while telavancin might be an effective alternative to vancomycin in MRSA infections, but caution is required during its clinical use due to the high risk of adverse events, especially nephrotoxicity.
This systematic review and meta-analysis of randomized controlled trials (RCTs) compared the clinical efficacy and safety of anti-MRSA cephalosporin and vancomycin-based treatment in treating acute bacterial skin and skin structure infections (ABSSSIs). PubMed, Embase, Cochrane Central Register of Controlled Trials, Turning Research into Practice, and ClinicalTrials.gov databases were searched for relevant articles from inception to 15 June 2020. RCTs comparing the clinical efficacy and safety of anti-MRSA cephalosporin with those of vancomycin-based regimens in treating adult patients with ABSSSIs were included. The primary and secondary outcomes were clinical response at the test-of-cure assessments and risk of adverse events (AEs), respectively. Eight RCTs were enrolled. The clinical response rate was not significantly different between anti-MRSA cephalosporin and vancomycin-based treatments (odds ratio [OR], 1.05; 95% CI, 0.90-1.23; I2 = 0%). Except for major cutaneous abscesses in which anti-MRSA cephalosporin-based treatment was associated with a lower clinical response rate than vancomycin-based treatment (OR, 0.62; 95% CI, 0.40-0.97; I2 = 0%), other subgroup analyses according to the type of cephalosporin (ceftaroline or ceftobiprole), type of infection, and different pathogens did not show significant differences in clinical response. Anti-MRSA cephalosporin-based treatment was only associated with a higher risk of nausea than vancomycin-based treatment (OR, 1.41; 95% CI, 1.07-1.85; I2 = 0%). In treating ABSSSIs, the clinical efficacy of anti-MRSA cephalosporin is comparable to that of vancomycin-based treatment, except in major cutaneous abscesses. In addition to nausea, anti-MRSA cephalosporin was as tolerable as vancomycin-based treatment.
OBJECTIVE: American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines suggest that linezolid (LZD) is preferred over vancomycin (VCM) for treating methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. We conducted a systematic review and comparative meta-analysis to compare VCM and LZD efficacy against proven MRSA pneumonia.
METHODS: We searched EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed up to November 2019. The outcomes of the meta-analysis were mortality, clinical cure, microbiological evaluation, and adverse events.
RESULTS: Seven randomized controlled trials (RCTs) with a total of 1239 patients and eight retrospective cohort or case-control studies (CSs) with a total 6125 patients were identified. Clinical cure and microbiological eradication rates were significantly increased in patients treated with LZD in RCTs (clinical cure: risk ratio (RR) = 0.81, 95% confidential interval (CI) = 0.71-0.92; microbiological eradication: RR = 0.71, 95% CI = 0.62-0.81) and CSs (clinical cure: odds ratio (OR) = 0.35, 95% CI = 0.18-0.69). However, mortality was comparable between patients treated with VCM and LZD in RCTs (RR = 1.08, 95% CI = 0.88-1.32) and CSs (OR = 1.20, 95% CI = 0.94-1.53). Likewise, there was no significant difference in adverse events between VCM and LZD in CSs (thrombocytopenia: OR = 0.95, 95% CI = 0.50-1.82; nephrotoxicity: OR = 1.72, 95% CI = 0.85-3.45).
CONCLUSIONS: According to our meta-analysis of RCTs and CSs conducted worldwide, we found robust evidence to corroborate the IDSA guidelines for the treatment of proven MRSA pneumonia.
期刊»International Journal of Clinical and Experimental Medicine
Year»2019
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BACKGROUND: Existing guidelines, clinical trials, and meta-analyses have provided conflicting conclusions regarding the comparison of clinical or microbiological efficacy of linezolid versus vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA)-related pneumonia. OBJECTIVE: This updated meta-analysis aimed to pool data comparing the efficacy and safety of linezolid versus vancomycin for treatment of MRSA-related pneumonia. METHODS: A systematic review with meta-analysis was performed by searching PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL), through April 4, 2018. Eligible studies that compared linezolid to vancomycin for subjects with MRSA-related infections, including pneumonia, were identified. This study analyzed outcomes for evaluation, including clinical success, microbiological success, mortality, therapy duration, days on mechanical ventilation, length of ICU stay, length of hospital stay, drug-related adverse events (DRAEs), and drug discontinuation. Main endpoints for efficacy outcomes were end of treatment (EOT) and end of study (EOS). Risk ratios (RRs) or mean differences (MDs), respectively, with 95% confidence intervals (CIs), were calculated for relevant comparisons of efficacy and safety. Heterogeneity of results for included studies was assessed using I2 statistics. RESULTS: Fifteen studies, encompassing 7,003 subjects with MRSA-related pneumonia, met the inclusion criteria. This meta-analysis found the superiority of linezolid to vancomycin in terms of higher clinical success at EOT [RR 1.18, 95% CI (1.10 - 1.27), p < 0.00001] and microbiological success at EOT [RR 1.39 (1.25 - 1.55), p < 0.00001] (both statistical power > 99.9%), along with lower occurrence of nephrotoxicity [RR 0.52 (0.36 - 0.73), p = 0.0002; power = 96.4%]. Results showed inferiority, however, regarding a higher occurrence of diarrhea [RR (1.24 - 3.74), p = 0.006; power = 88.9%]. The present meta-analysis also found comparable mortality [RR 0.93 (0.81 - 1.07); p = 0.31], incidence of total DRAEs [RR 1.19 (0.95 - 1.49), p = 0.14], and drug discontinuation [RR 1.02 (0.83 - 1.27), p = 0.82] between the two therapies. CONCLUSION: The present meta-analysis supports the claim that linezolid is an advantageous alternative to vancomycin for treatment of MRSA-related pneumonia, due to superior clinical and microbiological success at EOT and lower incidence of nephrotoxicity. This meta-analysis, at least partially, addressed the current controversy and public health concern regarding the optimal treatment for MRSA-related pneumonia.
This study aims to assess the clinical efficacy and safety of ceftaroline for the treatment of complicated skin and skin structure infections (cSSSIs) in adult patients through meta-analysis. PubMed, Embase, ClinicalTrials.gov, and Cochrane databases were searched up to April 2019. Only randomized controlled trials (RCTs) that evaluated ceftaroline and other comparators for treating cSSSIs in adult patients were included. The primary outcome was the clinical cure rate, whereas the secondary outcomes were clinical failure rate, microbiological eradication rate, relapse rate, and risk of an adverse event (AE). Five RCTs were included. Overall, ceftaroline had a clinical cure rate similar to comparators in the treatment of cSSSIs in the modified intent-to-treat population (risk ratio (RR), 1.00; 95% confidence interval (CI), 0.97-1.04; I2 = 0%) and in the clinically evaluable population (RR, 1.00; 95% CI, 0.97-1.03; I2 = 0%). In addition, no significant difference was observed between ceftaroline and comparators for the treatment of infection with Staphylococcus aureus (RR, 1.01; 95% CI, 0.98-1.05; I2 = 0%), methicillin-resistant S. aureus (RR, 0.99; 95% CI, 0.94-1.05; I2 = 0%), methicillin-susceptible S. aureus (RR, 1.01; 95% CI, 0.96-1.06; I2 = 26%), Streptococcus spp. (RR, 1.07; 95% CI, 0.92-1.24; I2 = 73%), and Gram-negative bacteria (RR, 0.94; 95% CI, 0.83-1.08; I2 = 0%). Furthermore, ceftaroline had a similar rate of microbiological eradication (92.2% vs. 92.6%, RR, 1.00; 95% CI, 0.97-1.03; I2 = 9%) and relapse (6.9% vs. 9.1%, RR, 0.48; 95% CI, 0.14-1.74; I2 = 0%) as comparators. Finally, the risks of treatment-emergent AEs (RR, 0.96; 95% CI, 0.88-1.05; I2 = 0%), serious AEs (RR, 1.03; 95% CI, 0.63-1.68; I2 = 0%), and discontinuation of study drug due to an AE (RR, 0.86; 95% CI, 0.50-1.49; I2 = 34%) did not differ significantly between ceftaroline and comparators. In conclusion, the clinical efficacy of ceftaroline is as high as that of comparators in the treatment of cSSSIs in adult patients, and this antibiotic is well tolerated like the comparators.
OBJECTIVE: This study aims to systematically compare the efficacy and safety of linezolid andvancomycinfor treatment of hospital-acquired pneumonia (HAP). METHODS: PubMed, EMbase, MEDLINE, The Cochrane Library, CNKI, VIP, and Wan Fang databases were searched. Relevant conference proceedings in Chinese or English were manually searched. Randomized controlled trials (RCTs) were included in this study. RevMan 5.2 software was applied to do Meta-analysis. RESULTS: Totally 6088 patients with HAP in 7 RCTs were included. The meta-analysis results showed that the response rates between Linezolid and Vancomycin had no significant difference [OR=1.11, 95% CI (0.98, 1.17), P=0.10]. As to pathogen eradication, the efficacy of linezolid or vancomycin had no significant difference [OR=1.16, 95% CI (0.97, 1.40), P=0.10]. The exit event rate in trials induced by linezolid or vancomycin had no significant difference (P=0.40), and the incidence of gastrointestinal adverse events by linezolid or vancomycin was also not significantly different (P=0.18). The risk of renal dysfunction was significantly higher in vancomycin group than in linezolid group [OR=0.51, 95% CI (0.36, 0.73), P=0.0002], while the thrombocytopenia was significantly higher in linezolid group than in vancomycin group [OR=1.27, 95% CI (1.03, 1.57), P=0.02]. CONCLUSION: The efficacy of linezolid and vancomycin was similar for treatment of HAP. The risk dysfunction induced by linezolid was significantly lower than that byvancomycin, while the thrombocytopenia caused by linezolid was significantly higher than that by vancomycin.
To evaluate the safety and efficacy of vancomycin with the other anti-Gram-positive bacteria antibiotics in the treatment of Staphylococcus aureus bacteraemia.
METHODS:
We searched the PubMed, MEDLINE, Embase and Cochrane Library databases until August 2022 for studies that compared vancomycin with other antibiotic regimens for treating Staphylococcus aureus bacteraemia. Clinical and microbiological responses, adverse events, relapse rate and mortality were considered.
RESULTS:
Fifteen randomized controlled trials and nine retrospective studies were included. The efficacy and safety data of vancomycin differed from those of the comparators group. After subgroup analysis, the differences came mainly from the trials compared with daptomycin. Compared to daptomycin, vancomycin showed a lower microbiological cure rate (OR = 0.58, 95% CI = 0.41∼0.82, I2 = 0%, P = 0.002) and clinical cure rate (OR = 0.53, 95% CI = 0.42∼0.68, I2 = 3%, P < 0.00001), as well as more adverse events (OR = 3.21, 95% CI = 1.43∼7.19, I2 = 59%, P = 0.005).
CONCLUSION:
The efficacy of vancomycin in treating Staphylococcus aureus bacteraemia is still excellent but slightly inferior in adverse events. However, this does not affect its use as a first-line drug. Daptomycin is expected to be a better antimicrobial drug.
