利奈唑胺与糖肽类药物治疗糖肽类敏感屎肠球菌血流感染的比较：一项倾向评分匹配的对比研究。

Linezolid vs glycopeptides in the treatment of glycopeptide-susceptible Enterococcus faecium bacteraemia: A propensity score matched comparative study.

机构信息

Service of Pharmacy, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona, Barcelona, Spain.

Service of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona, Barcelona, Spain.

出版信息

Int J Antimicrob Agents. 2019 Nov;54(5):572-578. doi: 10.1016/j.ijantimicag.2019.08.018. Epub 2019 Aug 30.

DOI:10.1016/j.ijantimicag.2019.08.018

PMID:31476435

Abstract

BACKGROUND

The incidence of ampicillin-resistant Enterococcus faecium bacteraemia is increasing. Vancomycin remains the first-line treatment in areas with a high prevalence of glycopeptide-susceptible isolates, but data comparing its clinical outcomes with other treatments are lacking. The objective of this study was to compare the effectiveness and safety of linezolid and glycopeptides for the treatment of glycopeptide-susceptible E. faecium bloodstream infection (GSEF-BSI).

METHODS

This retrospective observational cohort study was conducted from January 2006 to May 2018 at the Hospital del Mar, Barcelona, Spain, and compared the clinical outcomes and safety of linezolid and glycopeptides in adult patients with GSEF-BSI. The main outcomes included clinical cure at the end of therapy, 30-day mortality, microbiological eradication and attributable length of stay (LOS). Propensity score matching was performed to reduce potential confounders among groups.

RESULTS

In total, 105 patients with GSEF-BSI were included (linezolid, n=38; glycopeptides, n=67). After propensity score matched analysis, 56 (53.3%) patients, 28 in each cohort, entered the final analysis. No differences were observed in any of the main clinical outcomes among patients treated with linezolid or glycopeptides: clinical cure [16/28 (57.1%) vs 13/28 (46.4%), P=0.593], 30-day mortality [8/28 (28.6%) vs 12/28 (42.9%), P=0.403], microbiological eradication [22/28 (78.6%) vs 20/28 (71.4%), P=0.758] and median attributable LOS (18.0 vs 17.0 days, P=0.924). Adverse events were similar in both groups.

CONCLUSIONS

Linezolid and glycopeptides showed similar clinical effectiveness and safety in the treatment of GSEF-BSI. Linezolid could be an alternative to glycopeptides in the treatment of GSEF-BSI.

摘要

背景

氨苄西林耐药粪肠球菌血流感染的发病率正在上升。在糖肽敏感性分离株高发地区，万古霉素仍然是一线治疗药物，但缺乏比较其临床疗效与其他治疗方法的数据。本研究的目的是比较利奈唑胺和糖肽类药物治疗糖肽敏感粪肠球菌血流感染（GSEF-BSI）的疗效和安全性。

方法

这是一项回顾性观察性队列研究，于 2006 年 1 月至 2018 年 5 月在西班牙巴塞罗那的 Hospital del Mar 进行，比较了利奈唑胺和糖肽类药物治疗成人 GSEF-BSI 的临床疗效和安全性。主要结局包括治疗结束时的临床治愈率、30 天死亡率、微生物学清除率和归因于住院时间（LOS）。采用倾向评分匹配法减少组间潜在混杂因素。

结果

共纳入 105 例 GSEF-BSI 患者（利奈唑胺组 38 例，糖肽组 67 例）。经倾向评分匹配分析后，56 例（53.3%）患者，每组 28 例进入最终分析。利奈唑胺或糖肽类药物治疗的患者在任何主要临床结局方面均无差异：临床治愈率[28 例患者中的 16 例（57.1%）vs. 28 例患者中的 13 例（46.4%），P=0.593]、30 天死亡率[28 例患者中的 8 例（28.6%）vs. 28 例患者中的 12 例（42.9%），P=0.403]、微生物学清除率[28 例患者中的 22 例（78.6%）vs. 28 例患者中的 20 例（71.4%），P=0.758]和归因于 LOS 的中位数（18.0 天 vs. 17.0 天，P=0.924）。两组的不良事件相似。