Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Science, Ascension St. John Hospital, Wayne State University, Detroit, Michigan, USA.
Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, Michigan, USA.
Pharmacotherapy. 2020 Jul;40(7):648-658. doi: 10.1002/phar.2437. Epub 2020 Jul 6.
Observational and randomized controlled trials of the combination of vancomycin or daptomycin with a beta-lactam (BL) in patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia have shown conflicting results on patient outcomes.
The primary purpose of this meta-analysis was to compare clinical failure with the combination of vancomycin or daptomycin with a BL versus vancomycin or daptomycin monotherapy in MRSA bacteremia or endocarditis.
A systematic literature search of PubMed, Embase, CINAHL, and meeting proceedings was conducted from inception through February 11, 2020, to identify relevant studies. The primary outcome was clinical failure and secondary outcomes were mortality, nephrotoxicity, and bacteremia. The meta-analysis was performed using Comprehensive Meta Analysis (version 3.0) with a random effects model. Outcomes were reported as odds ratios (ORs) with corresponding 95% confidence intervals (CIs).
Nine studies of 1636 patients receiving vancomycin or daptomycin monotherapy versus the combination of vancomycin or daptomycin plus BL for MRSA bacteremia were included. Results showed combination therapy was associated with significantly lower clinical failure rates (OR 0.56, 95% CI 0.39-0.79, I = 26.22%, p=0.001). Improvement in clinical failure was driven by lower rates of bacteremia relapse and persistence. However, no difference was seen with mortality.
Combination therapy with vancomycin or daptomycin plus BL for MRSA bacteremia showed lower clinical failure rates, however, no significant difference was seen in mortality.
观察性研究和随机对照试验表明，万古霉素或达托霉素联合β-内酰胺类药物（BL）治疗耐甲氧西林金黄色葡萄球菌（MRSA）菌血症患者的临床结局存在冲突。
本荟萃分析的主要目的是比较万古霉素或达托霉素联合 BL 与万古霉素或达托霉素单药治疗 MRSA 菌血症或心内膜炎患者的临床失败率。
从建库到 2020 年 2 月 11 日，通过 PubMed、Embase、CINAHL 和会议记录系统进行系统文献检索，以确定相关研究。主要结局是临床失败，次要结局是死亡率、肾毒性和菌血症。使用 Comprehensive Meta Analysis（版本 3.0）进行荟萃分析，采用随机效应模型。使用比值比（ORs）及其相应的 95%置信区间（CIs）报告结果。
纳入了 9 项研究，共 1636 例接受万古霉素或达托霉素单药治疗与万古霉素或达托霉素联合 BL 治疗 MRSA 菌血症的患者。结果显示，联合治疗的临床失败率显著降低（OR 0.56，95%CI 0.39-0.79，I²=26.22%，p=0.001）。临床失败的改善是由于菌血症复发和持续率降低所致。然而，死亡率无差异。
万古霉素或达托霉素联合 BL 治疗 MRSA 菌血症的临床失败率较低，但死亡率无显著差异。
