Anti-MRSA Cephalosporin versus Vancomycin-Based Treatment for Acute Bacterial Skin and Skin Structure Infection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Anti-MRSA Cephalosporin versus Vancomycin-Based Treatment for Acute Bacterial Skin and Skin Structure Infection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
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DOI：
10.3390/antibiotics10081020
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发表时间：
2021-08-22
期刊：
影响因子：
--
通讯作者：
Tang HJ
中科院分区：
文献类型：
--
作者：
Chen CY;Chen WC;Lai CC;Shih TP;Tang HJ
这项随机对照试验的系统综述和荟萃分析比较了抗MRSA头孢菌素和万古霉素治疗急性细菌性皮肤和皮肤结构感染(ABSSSI)的临床疗效和安全性。检索PubMed、Embase、Cochrane Central Register of Control Trials、Turning Research to Practice和ClinicalTrials.gov数据库，检索从初始到2020年6月15日的相关文章。纳入随机对照试验，比较抗MRSA头孢菌素与以万古霉素为基础的方案治疗成人ABSSIS的临床疗效和安全性。主要和次要结果分别是治愈试验评估的临床反应和不良事件(AEs)的风险。共招募了8名随机对照试验。抗MRSA头孢菌素类药物与万古霉素类药物的临床有效率无显著差异(优势比[OR]，1.05；95%CI，0.90~1.23；I2=0)。除了主要的皮肤脓肿中，基于头孢菌素的抗MRSA治疗与基于万古霉素的治疗相比临床有效率较低(OR，0.62；95%CI，0.40-0.97；I2=0%)，根据头孢菌素的类型(头孢他林或头孢比洛尔)、感染类型和不同病原体进行的其他亚组分析没有显示出显著的临床反应差异。抗MRSA头孢菌素治疗仅比万古霉素治疗有更高的恶心风险(OR，1.41；95%CI，1.07-1.85；I2=0)。除主要皮肤脓肿外，抗MRSA头孢菌素治疗ABSSSI的临床疗效与基于万古霉素的治疗相当。除了恶心，抗MRSA头孢菌素与万古霉素治疗一样耐受。
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.
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