Linezolid vs Glycopeptide Antibiotics for the Treatment of Suspected Methicillin-Resistant Staphylococcus aureus Nosocomial Pneumonia A Meta-analysis of Randomized Controlled Trials-猫眼课题宝

DOI：

10.1378/chest.10-1556

发表时间：

2011-05-01

期刊：

CHEST

影响因子：

9.6

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Walkey, Allan J.;O'Donnell, Max R.;Wiener, Renda Soylemez

背景：耐甲氧西林金黄色葡萄球菌（MRSA）是引起医院获得性肺炎的重要原因。社会指南建议利奈唑胺可能是MRSA医院获得性肺炎的首选治疗。我们研究了利奈唑胺与糖肽类抗生素（万古霉素或替考拉宁）治疗院内获得性肺炎的疗效比较。方法：这是一项系统性综述和荟萃分析，比较利奈唑胺与糖肽类抗生素治疗> 12岁受试者疑似MRSA肺炎的英文随机对照试验。PubMed MEDLINE和科克伦对照试验数据库的一个高度敏感的搜索确定相关study.Results：8项试验，包括1,641名受试者符合入选标准。在临床成功终点方面，利奈唑胺并不上级优于糖肽类抗生素（相对风险[RR]利奈唑胺vs糖肽类，1.04; 95% CI，0.97-1.11; P = 0.28），微生物学成功（RR，1.13; 95% CI，0.97-1.31; P = .12）或死亡率（RR，0.91; 95% CI，0.69-1.18; P = .47）。此外，MRSA阳性呼吸道培养受试者亚组的临床成功率（RR，1.23; 95% CI，0.97-1.57; P = 0.09）与非MRSA受试者亚组无显著差异（RR，0.95; 95% CI，0.83-1.09; P = 0.48），相互作用P为0.07。两种抗生素类之间不良事件的风险无差异（RR，0.96; 95%CI，0.86-1.07; P = 0.48）。结论：随机对照试验不支持利奈唑胺治疗院内获得性肺炎优于糖肽类抗生素。我们建议，利奈唑胺或糖肽类抗生素经验性或MRSA导向治疗医院内肺炎的决定取决于当地的可用性，抗生素耐药模式，首选的输送途径和成本，而不是假设的疗效差异。胸部2011; 139（5）：1148-1155

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of nosocomial pneumonia. Societal guidelines suggest linezolid may be the preferred treatment of MRSA nosocomial pneumonia. We investigated the efficacy of linezolid compared with glycopeptide antibiotics (vancomycin or teicoplanin) for nosocomial pneumonia.Methods: This was a systematic review and meta-analysis of English language, randomized, controlled trials comparing linezolid to glycopeptide antibiotics for suspected MRSA pneumonia in subjects > 12 years of age. A highly sensitive search of PubMed MEDLINE and Cochrane Central Register of Controlled Trials databases identified relevant studies.Results: Eight trials encompassing 1,641 subjects met entry criteria. Linezolid was not superior to glycopeptide antibiotics for end points of clinical success (relative risk [RR] linezolid vs glycopeptide, 1.04; 95% CI, 0.97-1.11; P = .28), microbiologic success (RR, 1.13; 95% CI, 0.97-1.31; P = .12), or mortality (RR, 0.91; 95% CI, 0.69-1.18; P = .47). In addition, clinical success in the subgroup of subjects with MRSA-positive respiratory tract culture (RR, 1.23; 95% CI, 0.97-1.57; P = .09) was not significantly different from those without MRSA (RR, 0.95; 95% CI, 0.83-1.09; P = .48), P for interaction, 0.07. The risk for adverse events was not different between the two antibiotic classes (RR, 0.96; 95% CI, 0.86-1.07; P = .48).Conclusion: Randomized controlled trials do not support superiority of linezolid over glycopeptide antibiotics for the treatment of nosocomial pneumonia. We recommend that decisions between linezolid or glycopeptide antibiotics for empirical or MRSA-directed therapy of nosocomial pneumonia depend on local availability, antibiotic resistance patterns, preferred routes of delivery, and cost, rather than presumed differences in efficacy. CHEST 2011; 139(5):1148-1155

Linezolid vs Glycopeptide Antibiotics for the Treatment of Suspected Methicillin-Resistant Staphylococcus aureus Nosocomial Pneumonia A Meta-analysis of Randomized Controlled Trials

文献摘要

被引文献

相似文献