Pharmerit Europe, Rotterdam, The Netherlands.
Curr Med Res Opin. 2010 Jul;26(7):1565-78. doi: 10.1185/03007995.2010.481251.
With a growing number of studies and comparators in MRSA skin infections, a unified framework for comparing treatments is needed for health technology assessment (HTA). The objective was to systematically assess the success rates of common antimicrobial agents for the treatment of complicated skin and soft tissue infections (cSSTIs) caused by MRSA.
MEDLINE, EMBASE, and Cochrane databases were searched to identify published clinical trials in which dalbavancin, daptomycin, linezolid, telavancin, teicoplanin, tigecycline, and vancomycin were used to treat cSSTIs. Pooled efficacy estimates were generated from clinical and microbiological determinations of success for the MRSA-subgroups in cSSTI clinical trials using a Bayesian meta-analytic approach. Success rates for each antibiotic were reported with 95% Bayesian confidence intervals (called credible intervals [CrI]). In sensitivity analyses the impact of different model parameters and article quality were investigated.
Out of 36 identified studies, 14 studies on six antibiotics with 28 treatment arms (n = 1840) were included in the analysis. No MRSA data in cSSTI were found for teicoplanin. The pooled success rate and CrI(95%) for each agent was: vancomycin (74.7%; CrI(95%): 64.1%-83.5%), dalbavancin (87.7%; CrI(95%): 74.6%-95.4%), linezolid (84.4%; CrI(95%): 76.6%-90.6%), telavancin (83.5%; CrI(95%): 73.6%-90.8%), daptomycin (78.1%; CrI(95%): 54.6%-93.2%) and tigecycline (70.4%; CrI(95%): 48.0%-87.6%). Comparisons between antibiotics suggested differences versus vancomycin for linezolid (+9.7%; CrI(95%): 4.4%-15.8%), dalbavancin (+13.1%; CrI(95%): 1.0%-23.8%), and telavancin (+8.8%; CrI(95%): 1.5-16.7%). The finding of lower vancomycin efficacy in MRSA cSSTI did not change in sensitivity analyses.
The results of this meta-analysis suggest higher success rates for linezolid and the new glycopeptides (dalbavancin and telavancin) in MRSA-confirmed cSSTIs. The uncertainty margins reflect the study limitations including number of cases and indirect nature of the comparisons. This example of Bayesian meta-analysis for MRSA cSSTI provides a potential framework for comparisons that is useful for HTA and formulary decision-making.
随着耐甲氧西林金黄色葡萄球菌（MRSA）皮肤感染相关研究和对照的增多，需要为卫生技术评估（HTA）制定一个统一的框架来比较治疗方法。本研究旨在系统评估常见抗菌药物治疗 MRSA 引起的复杂性皮肤和软组织感染（cSSTIs）的成功率。
检索 MEDLINE、EMBASE 和 Cochrane 数据库，以确定使用达巴万星、达托霉素、利奈唑胺、替考拉宁、替加环素、万古霉素治疗 cSSTIs 的已发表临床试验。采用贝叶斯荟萃分析方法，根据 cSSTI 临床试验中临床和微生物学确定的 MRSA 亚组的成功情况，综合计算疗效估计值。报告每种抗生素的成功率，并给出 95%贝叶斯置信区间（称为可信区间 [CrI]）。在敏感性分析中，研究了不同模型参数和文章质量的影响。
在确定的 36 项研究中，有 14 项关于 6 种抗生素的研究共 28 个治疗臂（n = 1840）纳入分析。替考拉宁在 cSSTI 中没有 MRSA 数据。每种药物的汇总成功率和 CrI（95%）分别为：万古霉素（74.7%；CrI（95%）：64.1%-83.5%）、达巴万星（87.7%；CrI（95%）：74.6%-95.4%）、利奈唑胺（84.4%；CrI（95%）：76.6%-90.6%）、替拉万星（83.5%；CrI（95%）：73.6%-90.8%）、达托霉素（78.1%；CrI（95%）：54.6%-93.2%）和替加环素（70.4%；CrI（95%）：48.0%-87.6%）。与万古霉素相比，抗生素之间的比较表明利奈唑胺（+9.7%；CrI（95%）：4.4%-15.8%）、达巴万星（+13.1%；CrI（95%）：1.0%-23.8%）和替拉万星（+8.8%；CrI（95%）：1.5%-16.7%）存在差异。在敏感性分析中，万古霉素治疗 MRSA cSSTI 疗效较低的结果并未改变。
这项荟萃分析的结果表明，利奈唑胺和新型糖肽（达巴万星和替拉万星）在确诊为 MRSA 的 cSSTI 中具有更高的成功率。不确定性范围反映了研究的局限性，包括病例数量和比较的间接性。MRSA cSSTI 的贝叶斯荟萃分析示例为比较提供了一个潜在的框架，对 HTA 和处方决策制定很有用。
