Division of Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany.
Division of Infectious Diseases, Department of Diagnostics and Public Health, G.B. Rossi University Hospital, University of Verona, Verona, Italy.
Curr Opin Infect Dis. 2018 Apr;31(2):120-130. doi: 10.1097/QCO.0000000000000432.
Skin and soft-tissue infections (SSIs) are among the commonest infections encountered in clinical practice. Spread of methicillin-resistant Staphylococcus aureus SSIs continues to increase in both health care and community settings and presents a challenge for the best treatment choice. Vancomycin has been the mainstay of SSIs treatment, but recently its use has been questioned because of concerns about its efficacy, tolerability, and unfavorable pharmacokinetic/pharmacodynamic profile. The purpose of this review is to establish the current role for vancomycin in light of the literature published from January 2007 to September 2017 on comparison with both old and new alternatives.
Meta-analyses show better clinical and microbiological outcomes for drugs approved for the treatment of SSI, including those sustained by methicillin-resistant S. aureus, in the last 10 years than for vancomycin. The newer glycopeptides and linezolid decrease the total treatment costs compared with vancomycin, by reducing the length of stay or avoiding the hospitalization.
Vancomycin is noninferior in efficacy and safety to all comparator drugs, including the newest on the market. However, the SSI treatment evidence base presents several shortcomings limiting the clinical applicability of the results. High-level clinical trials should be performed to obtain results that can be generalized and applied effectively in clinical practice.
皮肤和软组织感染（SSI）是临床实践中最常见的感染之一。耐甲氧西林金黄色葡萄球菌（MRSA）引起的 SSI 在医疗和社区环境中的传播不断增加，这对最佳治疗方案的选择提出了挑战。万古霉素一直是 SSI 治疗的主要药物，但由于对其疗效、耐受性和不利的药代动力学/药效学特征的担忧，最近其应用受到了质疑。本综述的目的是根据 2007 年 1 月至 2017 年 9 月发表的文献，评估万古霉素在 SSI 治疗中的当前作用，并与旧的和新的替代药物进行比较。
荟萃分析显示，近 10 年来，与万古霉素相比，治疗 SSI 的获批药物（包括耐甲氧西林金黄色葡萄球菌 SSI）在临床和微生物学结局方面的效果更好。与万古霉素相比，新型糖肽类药物和利奈唑胺通过减少住院时间或避免住院，降低了总治疗费用。
万古霉素在疗效和安全性方面与所有对照药物均无差异，包括市场上最新的药物。然而，SSI 治疗的证据基础存在一些缺陷，限制了研究结果的临床适用性。应进行高级别的临床试验，以获得可在临床实践中推广和有效应用的结果。
