利奈唑胺与糖肽类抗生素治疗疑似耐甲氧西林金黄色葡萄球菌医院获得性肺炎的比较：一项随机对照试验的荟萃分析。
Linezolid vs glycopeptide antibiotics for the treatment of suspected methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a meta-analysis of randomized controlled trials.
机构信息
Boston University School of Medicine, The Pulmonary Center, Boston, MA.
Albert Einstein College of Medicine, Division of Pulmonary Medicine, Bronx, NY.
出版信息
Chest. 2011 May;139(5):1148-1155. doi: 10.1378/chest.10-1556. Epub 2010 Sep 23.
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.
背景
耐甲氧西林金黄色葡萄球菌（MRSA）是医院获得性肺炎的重要病因。社会指南建议利奈唑胺可能是治疗 MRSA 医院获得性肺炎的首选药物。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）治疗医院获得性肺炎的疗效。
方法
这是一项系统评价和荟萃分析，检索了英语随机对照试验，比较了利奈唑胺与糖肽类抗生素治疗年龄大于 12 岁的疑似 MRSA 肺炎患者的疗效。对 PubMed MEDLINE 和 Cochrane 对照试验中心注册数据库进行了高敏度检索，以确定相关研究。
结果
八项试验共纳入 1641 例患者，符合纳入标准。利奈唑胺在临床疗效（利奈唑胺与糖肽类抗生素的相对风险 [RR]，1.04；95%置信区间 [CI]，0.97-1.11；P =.28）、微生物学疗效（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）方面均不优于糖肽类抗生素。此外，MRSA 阳性呼吸道培养亚组患者的临床疗效（RR，1.23；95%CI，0.97-1.57；P =.09）与无 MRSA 患者的临床疗效（RR，0.95；95%CI，0.83-1.09；P =.48）无显著差异，组间差异 P 值为 0.07。两种抗生素类别的不良反应风险无差异（RR，0.96；95%CI，0.86-1.07；P =.48）。
结论
随机对照试验并不支持利奈唑胺优于糖肽类抗生素治疗医院获得性肺炎。我们建议，在选择利奈唑胺或糖肽类抗生素经验性治疗或针对 MRSA 治疗医院获得性肺炎时，应根据当地药物可获得性、抗生素耐药模式、首选给药途径和成本来决定，而不是基于假定的疗效差异。
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