University of Nebraska Medical Center, Omaha, NE, USA.
Crit Care Med. 2010 Sep;38(9):1802-8. doi: 10.1097/CCM.0b013e3181eb3b96.
Compared with glycopeptides, linezolid achieves higher lung epithelial lining fluid concentrations, which may correlate with improved efficacy in the treatment of nosocomial pneumonia. However, clinical superiority has not been demonstrated.
To test the hypothesis that linezolid may be superior to glycopeptides.
Prospective randomized trials that tested linezolid vs. vancomycin or teicoplanin for treatment of nosocomial pneumonia were included. Heterogeneity was analyzed by I(2) and Q statistics. Meta-analysis relative risks were based on fixed and random-effects models. Outcomes evaluated consisted of clinical cure, microbiological eradication, and side effects.
Nine linezolid trials (vancomycin [7]; teicoplanin [2]) were included (n = 2329). The linezolid vs. glycopeptide analysis shows clinical cure relative risk of 1.01 (95% confidence interval, 0.93-1.10; p = .83; I(2) = 0%) and microbiological eradication relative risk of 1.10 (95% confidence interval, 0.98 -1.22; p = .10; I(2) = 0%). Methicillin-resistant Staphylococcus aureus subgroup analysis yielded a microbiological eradication relative risk of 1.10 (95% confidence interval, 0.87-1.38; p = .44; I(2) = 16%). If linezolid is compared with vancomycin only, then clinical cure relative risk is 1.00 (95% confidence interval, 0.90-1.12), microbiological eradication and methicillin-resistant Staphylococcus aureus relative risks are 1.07 (95% confidence interval, 0.90-1.26; p = .45) and 1.05 (95% confidence interval, 0.82-1.33; p = .71). The risks of thrombocytopenia (relative risk, 1.93; 95% confidence interval, 1.30-2.87; p = .001) and gastrointestinal events (relative risk, 2.02; 95% confidence interval, 1.10-3.70; p = .02) are higher with linezolid, but no differences are seen for renal dysfunction (relative risk, 0.89; 95% confidence interval, 0.56-1.43; p = .64) or all-cause mortality (relative risk, 0.95; 95% confidence interval, 0.76-1.18; p = .63).
Our study does not demonstrate clinical superiority of linezolid vs. glycopeptides for the treatment of nosocomial pneumonia despite a statistical power of 95%. Linezolid shows a significant two-fold increase in the risk of thrombocytopenia and gastrointestinal events. Vancomycin and teicoplanin are not associated with more renal dysfunction than linezolid.
与糖肽类药物相比，利奈唑胺在肺上皮衬液中的浓度更高，这可能与治疗医院获得性肺炎的疗效改善有关。然而，其临床优势尚未得到证实。
检验利奈唑胺可能优于糖肽类药物的假设。
纳入了评估利奈唑胺与万古霉素或替考拉宁治疗医院获得性肺炎的前瞻性随机试验。通过 I(2)和 Q 统计分析异质性。基于固定和随机效应模型的荟萃分析相对风险。评估的结果包括临床治愈率、微生物清除率和副作用。
共纳入了 9 项利奈唑胺试验（万古霉素 [7]；替考拉宁 [2]）（n = 2329）。利奈唑胺与糖肽类药物的分析显示，临床治愈率的相对风险为 1.01（95%置信区间，0.93-1.10；p =.83；I(2) = 0%），微生物清除率的相对风险为 1.10（95%置信区间，0.98-1.22；p =.10；I(2) = 0%）。耐甲氧西林金黄色葡萄球菌亚组分析显示，微生物清除率的相对风险为 1.10（95%置信区间，0.87-1.38；p =.44；I(2) = 16%）。如果将利奈唑胺与万古霉素进行比较，那么临床治愈率的相对风险为 1.00（95%置信区间，0.90-1.12），微生物清除率和耐甲氧西林金黄色葡萄球菌的相对风险分别为 1.07（95%置信区间，0.90-1.26；p =.45）和 1.05（95%置信区间，0.82-1.33；p =.71）。利奈唑胺的血小板减少症（相对风险，1.93；95%置信区间，1.30-2.87；p =.001）和胃肠道事件（相对风险，2.02；95%置信区间，1.10-3.70；p =.02）风险更高，但肾功能不全（相对风险，0.89；95%置信区间，0.56-1.43；p =.64）或全因死亡率（相对风险，0.95；95%置信区间，0.76-1.18；p =.63）无差异。
尽管我们的研究具有 95%的统计效力，但并未显示利奈唑胺在治疗医院获得性肺炎方面优于糖肽类药物的临床优势。利奈唑胺血小板减少症和胃肠道事件的风险显著增加了两倍。万古霉素和替考拉宁与利奈唑胺相比，肾功能不全的风险没有增加。
